Provider Demographics
NPI:1891771390
Name:NEWCOMB, REX A (OD)
Entity Type:Individual
Prefix:
First Name:REX
Middle Name:A
Last Name:NEWCOMB
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:PO BOX 80
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MO
Mailing Address - Zip Code:65622-0080
Mailing Address - Country:US
Mailing Address - Phone:417-345-2901
Mailing Address - Fax:417-345-2904
Practice Address - Street 1:112 W COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MO
Practice Address - Zip Code:65622-7614
Practice Address - Country:US
Practice Address - Phone:417-345-2901
Practice Address - Fax:417-345-2904
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO2572152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT42541Medicare UPIN