Provider Demographics
NPI:1780686659
Name:NEWTON OPTOMETRIC CENTER, PLLC
Entity type:Organization
Organization Name:NEWTON OPTOMETRIC CENTER, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:J.
Authorized Official - Middle Name:RICK
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:828-464-4136
Mailing Address - Street 1:PO BOX 446
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-0446
Mailing Address - Country:US
Mailing Address - Phone:828-464-4136
Mailing Address - Fax:828-464-6243
Practice Address - Street 1:750 IRIS LANE
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NC
Practice Address - Zip Code:28658-3343
Practice Address - Country:US
Practice Address - Phone:828-464-4136
Practice Address - Fax:828-464-6243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89015CAMedicaid
NC5404920001Medicare NSC
NC2335630Medicare PIN