Provider Demographics
NPI:1518924307
Name:NEWBERRY, ERIC KEITH (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:KEITH
Last Name:NEWBERRY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 W VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-7864
Mailing Address - Country:US
Mailing Address - Phone:972-562-0101
Mailing Address - Fax:972-562-0406
Practice Address - Street 1:1716 W VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-7864
Practice Address - Country:US
Practice Address - Phone:972-562-0101
Practice Address - Fax:972-562-0406
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5516TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU70902Medicare UPIN
TX00512HMedicare PIN
TX00512HMedicare ID - Type Unspecified