1427340124 NPI number — NEWSOM EYE & LASER CENTER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427340124 NPI number — NEWSOM EYE & LASER CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEWSOM EYE & LASER CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427340124
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13904 N DALE MABRY HWY STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33618-2446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-908-2020
Provider Business Mailing Address Fax Number:
813-908-2133

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13904 N DALE MABRY HWY
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33618-2446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-908-2020
Provider Business Practice Location Address Fax Number:
813-908-2133
Provider Enumeration Date:
05/12/2011

Additional Information

Authorized Official

Authorized Official Last Name:
NEWSOM
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
HUNTER
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
813-908-2020

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPC3003 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: ME79937 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: K2730A . This is a "PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4163540003 . This is a "NSC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 271214802 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com