Individual
KEVIN J WATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6310 N MAIN ST, STE A, DAYTON, OH 45415-3148
(937) 274-2733
(937) 274-2737
Mailing address
PO BOX 1314, DAYTON, OH 45401-1314
(937) 274-2733
(937) 274-2737
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
22111
NE
207W00000X
Ophthalmology Physician
Primary
71393
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00042
BLUE CROSS BLUE SHIELD
NE
05
—
2111324
—
OH
05
—
47082635818
—
NE
Enumeration date
12/28/2005
Last updated
02/14/2024
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