Provider Demographics
NPI:1366554651
Name:C. WATT TATE O.D. AND ASSOCIATES, INC.
Entity type:Organization
Organization Name:C. WATT TATE O.D. AND ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:WATSON
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-795-0791
Mailing Address - Street 1:15400 FLADT RD
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-9517
Mailing Address - Country:US
Mailing Address - Phone:614-795-0791
Mailing Address - Fax:
Practice Address - Street 1:1325 CAMERON AVE
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-9662
Practice Address - Country:US
Practice Address - Phone:614-888-3972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5664152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty