Provider Demographics
NPI:1497836779
Name:NEWHOUSE, BEVERLY SUE (OD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:SUE
Last Name:NEWHOUSE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1615 W LEAGUE CITY PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-7458
Mailing Address - Country:US
Mailing Address - Phone:281-554-7080
Mailing Address - Fax:281-554-3700
Practice Address - Street 1:1615 W LEAGUE CITY PKWY
Practice Address - Street 2:STE 100
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-7458
Practice Address - Country:US
Practice Address - Phone:281-554-7080
Practice Address - Fax:281-554-3700
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX6234TG152WC0802X, 152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156970901Medicaid
TX156970901Medicaid
TX156970901Medicaid
TXU91863Medicare UPIN