Provider Demographics
NPI:1467683656
Name:CLARKE D. NEWMAN, OD, PC
Entity Type:Organization
Organization Name:CLARKE D. NEWMAN, OD, PC
Other - Org Name:PLAZA VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARKE
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:214-969-0467
Mailing Address - Street 1:600 N PEARL ST
Mailing Address - Street 2:SUITE G-204
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-2822
Mailing Address - Country:US
Mailing Address - Phone:214-969-0467
Mailing Address - Fax:214-969-0468
Practice Address - Street 1:600 N PEARL ST
Practice Address - Street 2:SUITE G-204
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-2822
Practice Address - Country:US
Practice Address - Phone:214-969-0467
Practice Address - Fax:214-969-0468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3669TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000E46VMedicaid
T92500Medicare UPIN
TX0A4896Medicare PIN