Healthcare Provider Details

I. General information

NPI: 1548030661
Provider Name (Legal Business Name): NEWSOM EYE & LASER CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 NW 41ST ST
GAINESVILLE FL
32606-6630
US

IV. Provider business mailing address

13904 N DALE MABRY HWY STE 200
TAMPA FL
33618-2446
US

V. Phone/Fax

Practice location:
  • Phone: 352-377-7733
  • Fax:
Mailing address:
  • Phone: 813-908-2020
  • Fax: 813-908-2133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: STACY NEWSOM
Title or Position: CFO
Credential:
Phone: 813-908-2020