Healthcare Provider Details

I. General information

NPI: 1841309713
Provider Name (Legal Business Name): RICHARD LYNN NEWCOMB OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 06/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 N JEFFERSON ST
CARROLLTON MO
64633-1945
US

IV. Provider business mailing address

1411 N JEFFERSON ST
CARROLLTON MO
64633-1945
US

V. Phone/Fax

Practice location:
  • Phone: 660-542-2715
  • Fax: 660-542-2227
Mailing address:
  • Phone: 660-542-2715
  • Fax: 660-542-2227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT02635
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: