Healthcare Provider Details

I. General information

NPI: 1609856764
Provider Name (Legal Business Name): MATTHEW EARL NEWTON O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 466
FPO AP
96595
US

IV. Provider business mailing address

137 SETON HILL RD
WILLIAMSBURG VA
23188-1579
US

V. Phone/Fax

Practice location:
  • Phone: 0112463704200
  • Fax: 0112463704217
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4220
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618000445
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: