Provider Demographics
NPI:1093028219
Name:ROBERTSON OCULAR WATTERS CREEK LLC
Entity type:Organization
Organization Name:ROBERTSON OCULAR WATTERS CREEK LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REID
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:214-495-0095
Mailing Address - Street 1:941 W BETHANY DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3739
Mailing Address - Country:US
Mailing Address - Phone:214-495-0095
Mailing Address - Fax:214-785-6651
Practice Address - Street 1:918 WATTERS CREEK BLVD
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3734
Practice Address - Country:US
Practice Address - Phone:214-495-0095
Practice Address - Fax:214-785-6651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-16
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7583T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty