Basic Information
| Provider Information | |||||||||
| NPI: | 1295265205 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WATSON | ||||||||
| FirstName: | WHITNEY | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1950 OLD GALLOWS RD STE 520 | ||||||||
| Address2: | |||||||||
| City: | VIENNA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221823970 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 705 BUTTERMILK PIKE STE 100 | ||||||||
| Address2: | |||||||||
| City: | CRESCENT SPRINGS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410171318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593413937 | ||||||||
| FaxNumber: | 8593413940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2017 | ||||||||
| LastUpdateDate: | 04/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 6588 | OH | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 2081DT | KY | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.