Healthcare Provider Details

I. General information

NPI: 1235230749
Provider Name (Legal Business Name): JOYCE ANN NEWTON O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 NW STEWART PKWY
ROSEBURG OR
97470-1693
US

IV. Provider business mailing address

PO BOX 1232
SUTHERLIN OR
97479-1232
US

V. Phone/Fax

Practice location:
  • Phone: 541-957-8537
  • Fax:
Mailing address:
  • Phone: 541-459-3436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3093T
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: