Provider Demographics
NPI:1245268184
Name:WATSON, WILLIAM E (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:E
Last Name:WATSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 W. CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351
Mailing Address - Country:US
Mailing Address - Phone:936-327-3821
Mailing Address - Fax:936-327-4970
Practice Address - Street 1:1110 W. CHURCH ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351
Practice Address - Country:US
Practice Address - Phone:936-327-3821
Practice Address - Fax:936-327-4970
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1952152W00000X
TX01952152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112446301Medicaid
TX00E86HOtherBLUE CROSS BLUE SHIELD
TX1010100001Medicare NSC
TX112446301Medicaid
TX00E86HMedicare ID - Type Unspecified