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General NPI Number Information
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NPI Number | 1932306180
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Entity Type | Individual
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Provider Name | JENNIFER WILBECK NEWBY O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 66 HUGHES RD
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City | MADISON
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State | AL
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Zip | 35758-2220
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Country | US
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Telephone | 256-461-7100
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Fax | 256-461-7101
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Provider Business Mailing Address
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Address Line | 66 HUGHES RD
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City | MADISON
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State | AL
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Zip | 35758-2220
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Country | US
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Telephone | 256-461-7100
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Fax | 256-461-7101
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | S-B67-TA-761
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License Number State | AL
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