Provider Demographics
NPI:1932247954
Name:NEWCOMER, JAY D (OD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:D
Last Name:NEWCOMER
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 1:3636 N LECANTO HWY
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34465-3513
Mailing Address - Country:US
Mailing Address - Phone:352-746-0800
Mailing Address - Fax:352-527-1358
Practice Address - Street 1:3636 N LECANTO HWY
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:FL
Practice Address - Zip Code:34465-3513
Practice Address - Country:US
Practice Address - Phone:352-746-0800
Practice Address - Fax:352-527-1358
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2301152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL410048608OtherRAILROAD MEDICARE
FLU09603Medicare UPIN
FL19170ZMedicare ID - Type Unspecified