Individual
JACOB CHARLES WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
901 12TH AVE S, NAMPA, ID 83651-4658
(208) 466-9251
(208) 463-1714
Mailing address
901 12TH AVE S, NAMPA, ID 83651-4658
(208) 466-9251
(208) 463-1714
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-100302
ID
Other
Enumeration date
10/19/2011
Last updated
11/10/2014
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