Provider Demographics
NPI:1821896531
Name:WATTERS VISION EYE CARE, PS
Entity type:Organization
Organization Name:WATTERS VISION EYE CARE, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DERIK
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:HARDESTY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-687-0755
Mailing Address - Street 1:101 NW 12TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-9145
Mailing Address - Country:US
Mailing Address - Phone:360-687-0755
Mailing Address - Fax:360-666-8664
Practice Address - Street 1:101 NW 12TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-9145
Practice Address - Country:US
Practice Address - Phone:360-687-0755
Practice Address - Fax:360-666-8664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-06
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty