Provider Demographics
NPI:1669416400
Name:WATTS, AMY CROTEAU (OD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:CROTEAU
Last Name:WATTS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-3002
Mailing Address - Country:US
Mailing Address - Phone:617-573-3185
Mailing Address - Fax:617-573-6871
Practice Address - Street 1:243 CHARLES ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3002
Practice Address - Country:US
Practice Address - Phone:617-573-3185
Practice Address - Fax:617-573-6871
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4315152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM00PA25OtherBC BS OF NM
NM74986201Medicaid
NMP00323162OtherRRB MEDICARE RAILROAD
NM343533302Medicare ID - Type Unspecified
NMV07395Medicare UPIN