Healthcare Provider Details

I. General information

NPI: 1265642664
Provider Name (Legal Business Name): SUSAN D MENCARINI & JAY A NEWSOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 POLLASKY AVE
CLOVIS CA
93612-1139
US

IV. Provider business mailing address

305 POLLASKY AVE
CLOVIS CA
93612-1139
US

V. Phone/Fax

Practice location:
  • Phone: 559-298-2120
  • Fax: 559-299-3741
Mailing address:
  • Phone: 559-298-2120
  • Fax: 559-299-3741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number09054T
License Number StateCA

VIII. Authorized Official

Name: DR. JAY A. NEWSOME
Title or Position: OWNER
Credential: O.D.
Phone: 559-298-2120