Provider Demographics
NPI:1649367442
Name:NEWCOMB, JANET ANNE (OD)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:ANNE
Last Name:NEWCOMB
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:ANNE
Other - Last Name:SCHROEDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1225 EUREKA WAY # A
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0815
Mailing Address - Country:US
Mailing Address - Phone:530-241-9650
Mailing Address - Fax:
Practice Address - Street 1:1225 EUREKA WAY # A
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0815
Practice Address - Country:US
Practice Address - Phone:530-241-9650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12486T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA202366466OtherEIN
CA5628170001Medicare NSC
CA202366466OtherEIN
CASD0124860Medicare PIN