Provider Demographics
NPI:1568630598
Name:NEWMAN EYE CLINIC
Entity Type:Organization
Organization Name:NEWMAN EYE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:STANTON
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:228-467-1020
Mailing Address - Street 1:299 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:BAY ST LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520-3606
Mailing Address - Country:US
Mailing Address - Phone:228-467-1020
Mailing Address - Fax:228-467-7258
Practice Address - Street 1:299 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:BAY ST LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520-3606
Practice Address - Country:US
Practice Address - Phone:228-467-1020
Practice Address - Fax:228-467-7258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS524152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
410046800OtherRAILROAD MEDICARE
MS0830067/426083155-00OtherUNITEDHEALTHCARE
MS00087081OtherMEDICAID SERVICE PROVIDER
MS5727622OtherAETNA
MS9013468Medicaid
MS426083155COtherBLUECROSSBLUESHIELD
MS9013468Medicaid
410046800OtherRAILROAD MEDICARE
MS410000066Medicare PIN