Provider Demographics
NPI:1447294558
Name:WATKINS, TORRENCE A (OD)
Entity type:Individual
Prefix:DR
First Name:TORRENCE
Middle Name:A
Last Name:WATKINS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1875 E STEPHENS DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-4253
Mailing Address - Country:US
Mailing Address - Phone:480-414-5022
Mailing Address - Fax:602-237-1205
Practice Address - Street 1:5030 W BASELINE RD
Practice Address - Street 2:SUITE #135
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-7331
Practice Address - Country:US
Practice Address - Phone:602-237-4777
Practice Address - Fax:602-237-1205
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZP0580A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
164225OtherAHCCCS
164225OtherAHCCCS
AZU98069Medicare UPIN