Provider Demographics
NPI:1194809681
Name:NEWTON OPTOMETRIC CENTER P C
Entity type:Organization
Organization Name:NEWTON OPTOMETRIC CENTER P C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:ELIAS
Authorized Official - Last Name:SASSAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:641-792-7900
Mailing Address - Street 1:100 N 4TH AVE W
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-3141
Mailing Address - Country:US
Mailing Address - Phone:641-792-7900
Mailing Address - Fax:641-792-8663
Practice Address - Street 1:100 N 4TH AVE W
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-3141
Practice Address - Country:US
Practice Address - Phone:641-792-7900
Practice Address - Fax:641-792-8663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0195255Medicaid
IA19525OtherBLUE CROSS BLUE SHIELD
IA0424180002Medicare NSC