Individual
DR. MARK RAYMOND WATSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
3175 CHENEY HWY, TITUSVILLE, FL 32780-5979
(321) 383-8040
(321) 267-1544
Mailing address
3437 DEER OAK CIR, OVIEDO, FL 32766-8111
(904) 589-8512
(904) 579-4268
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC-4076
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CX186A
MEDICARE PTAN
FL
Enumeration date
01/23/2006
Last updated
09/24/2014
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