Provider Demographics
NPI:1215929831
Name:NEWSOME, JAY ANAND (OD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:ANAND
Last Name:NEWSOME
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 POLLASKY AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-1139
Mailing Address - Country:US
Mailing Address - Phone:559-298-2120
Mailing Address - Fax:559-299-3741
Practice Address - Street 1:305 POLLASKY AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-1139
Practice Address - Country:US
Practice Address - Phone:559-298-2120
Practice Address - Fax:559-299-3741
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA09054TPG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA410025521OtherRAILROAD MEDICARE
CASD0090540Medicaid
CASD0090540Medicaid
CA410025521OtherRAILROAD MEDICARE
CA0506780001Medicare NSC