Basic Information
| Provider Information | |||||||||
| NPI: | 1821274606 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DONALD L WATSON, OD AND ASSOCIATES, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7203 HODGSON MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314061504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123529356 | ||||||||
| FaxNumber: | 9123529105 | ||||||||
| Practice Location | |||||||||
| Address1: | 7203 HODGSON MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314061504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123529356 | ||||||||
| FaxNumber: | 9123529105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2008 | ||||||||
| LastUpdateDate: | 06/05/2008 | ||||||||
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| AuthorizedOfficialLastName: | WATSON | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9123529356 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPT000823 | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 000891382B | 05 | GA | MEDICAID |