Provider Demographics
NPI:1225039993
Name:NEWSOME, PAULA RENEE (OD, MS, FAAO)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:RENEE
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:OD, MS, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4002
Mailing Address - Country:US
Mailing Address - Phone:704-375-3935
Mailing Address - Fax:704-333-7238
Practice Address - Street 1:1016 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4002
Practice Address - Country:US
Practice Address - Phone:704-375-3935
Practice Address - Fax:704-333-7238
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2007-09-19
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-05-02
Provider Licenses
StateLicense IDTaxonomies
NC1087152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909651Medicaid
NC246433Medicare ID - Type Unspecified