Provider Demographics
NPI:1447994983
Name:WATKINS, KORI (OD)
Entity type:Individual
Prefix:DR
First Name:KORI
Middle Name:
Last Name:WATKINS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:
Practice Address - Street 1:11945 SAN JOSE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-1612
Practice Address - Country:US
Practice Address - Phone:904-262-2249
Practice Address - Fax:904-268-8283
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT128558109934152W00000X, 152WC0802X
390200000X
FLOPC6380152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program