Healthcare Provider Details

I. General information

NPI: 1225039993
Provider Name (Legal Business Name): PAULA RENEE NEWSOME OD, MS, FAAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date: 03/22/2006
Reactivation Date: 05/02/2006

III. Provider practice location address

1016 S CHURCH ST
CHARLOTTE NC
28203-4002
US

IV. Provider business mailing address

1016 S CHURCH ST
CHARLOTTE NC
28203-4002
US

V. Phone/Fax

Practice location:
  • Phone: 704-375-3935
  • Fax: 704-333-7238
Mailing address:
  • Phone: 704-375-3935
  • Fax: 704-333-7238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1087
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: