Organization
MICHAEL WATTERS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LINDSEY HELEN YOUNG (BILLING CLERK)
(405) 273-7075
Entity
Organization
Contact information
Practice address
2020 N HARRISON, SHAWNEE, OK 74804
(405) 273-7075
(405) 273-7405
Mailing address
2020 N HARRISON, SHAWNEE, OK 74804
(405) 273-7075
(405) 273-7405
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2408
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200046010A
—
OK
01
—
900522241
MEDICARE GROUP NUMBER
OK
Enumeration date
06/14/2007
Last updated
06/26/2008
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