Provider Demographics
NPI:1245236314
Name:NEWELL, CHRISTINE G (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:G
Last Name:NEWELL
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 1:52 PORTLAND RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04009-1235
Mailing Address - Country:US
Mailing Address - Phone:207-647-2030
Mailing Address - Fax:207-647-5030
Practice Address - Street 1:52 PORTLAND RD
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-1235
Practice Address - Country:US
Practice Address - Phone:207-647-2030
Practice Address - Fax:207-647-5030
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME874152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEU21471Medicare UPIN
MEME 1254Medicare PIN