Provider Demographics
NPI:1659943363
Name:NEWCOMER, CHARLES ISAAC (OD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ISAAC
Last Name:NEWCOMER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:150 INTERSTATE SOUTH DRIVE SUITE 200
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143
Mailing Address - Country:US
Mailing Address - Phone:678-454-7329
Mailing Address - Fax:678-454-7331
Practice Address - Street 1:150 INTERSTATE SOUTH DRIVE SUITE 200
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143
Practice Address - Country:US
Practice Address - Phone:678-454-7329
Practice Address - Fax:678-454-7331
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003324152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist