Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2588 | CT |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 2588 | CT |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | 2588 | CT |
N | 152WP0200X | Pediatric Optomitrist | 2588 | CT |
N | 152WV0400X | Optomitrist - Vision Therapist | 2588 | CT |
N | 152WX0102X | Occupational Vision | 2588 | CT |
NPI | 1194795948 |
---|---|
Provider Name | Dr. Keith E Watson |
First Address | Vernon, CT 06066-4517 |
Second Address | Vernon, CT 06066-4517 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 08/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
83550 | (02) | CT |