Individual
MR. BLAINE KENNETH WATKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1155 S POWER RD, SUITE 102, MESA, AZ 85206-3715
(210) 319-8099
Mailing address
1155 S POWER RD, SUITE 102, MESA, AZ 85206-3715
(210) 319-8099
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2060
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/15/2011
Last updated
07/15/2015
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