Kevin Lynn Watters, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

3123 Issued in WA

Practice address

101 NW 12TH Ave
Suite 101
Battle Ground, WA 98604-9141

Phone

(360) 687-0755

Fax

(360) 666-8664

NPI assigned

Jul 5, 2006

Last updated

Dec 3, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Watters Vision Care Inc

  • Optometrist
  • Battle Ground, WA
  • NPI 1912235078
  Authorized official Same address or phone
• Spec'D Out Eye Care, PS

  • Optometrist
  • Battle Ground, WA
  • NPI 1821896531
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1259798400000",
    "number": "1699706986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 NW 12TH AVE",
            "address_2": "SUITE 101",
            "city": "BATTLE GROUND",
            "state": "WA",
            "postal_code": "986049141",
            "telephone_number": "360-687-0755",
            "fax_number": "360-666-8664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 NW 12TH AVE",
            "address_2": "SUITE 101",
            "city": "BATTLE GROUND",
            "state": "WA",
            "postal_code": "986049141",
            "telephone_number": "360-687-0755",
            "fax_number": "360-666-8664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATTERS",
        "first_name": "KEVIN",
        "middle_name": "LYNN",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2009-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "3123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2016855",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lynne M Walters, R.N.
• Washington Dental Corporation, PC (Battle Ground Smiles Dentistry)
• Water Lily Therapeutic Massage & Sauna LLC
• Amber Renay Watson, LMT
• Watters Vision Care Inc
• Wave Anesthesia LLC
• Mark Callister Weed, D.O.
• Cheryl S Weiler, LMP
• Karrisa Jean Wessa, LMP
• Courtney L. White, DO

• Optometrist in Battle Ground, WA
• Providers in Battle Ground, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.