Provider Demographics
NPI:1598753808
Name:NEWMAN, CLARKE D (OD)
Entity Type:Individual
Prefix:DR
First Name:CLARKE
Middle Name:D
Last Name:NEWMAN
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 1:600 N PEARL ST
Mailing Address - Street 2:SUITE G-204
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-7492
Mailing Address - Country:US
Mailing Address - Phone:214-969-0467
Mailing Address - Fax:214-969-0468
Practice Address - Street 1:700 N PEARL ST STE N200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-7428
Practice Address - Country:US
Practice Address - Phone:214-969-0467
Practice Address - Fax:214-969-0468
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3669TG152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019356701Medicaid
TXT92500Medicare UPIN
TX019356701Medicaid
TX00E43VMedicare PIN