Healthcare Provider Details

I. General information

NPI: 1104206994
Provider Name (Legal Business Name): NEWSOM EYE & LASER CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 US HIGHWAY 27 N
SEBRING FL
33870
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 863-385-1544
  • Fax: 863-385-1233
Mailing address:
  • Phone: 813-908-2020
  • Fax: 813-908-2133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: THOMAS HUNTER NEWSOM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 863-385-1544