Provider Demographics
NPI:1578120523
Name:NEWMAN, MICHELE DAVIDSON (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:DAVIDSON
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1107
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-1107
Mailing Address - Country:US
Mailing Address - Phone:803-781-2123
Mailing Address - Fax:803-749-0183
Practice Address - Street 1:121 LUCY LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7835
Practice Address - Country:US
Practice Address - Phone:803-217-2550
Practice Address - Fax:803-217-2548
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC506156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician