Provider Demographics
NPI:1548257074
Name:NEWTON, CARL WADE (OD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:WADE
Last Name:NEWTON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1504 S GRAND AVE
Mailing Address - Street 2:POB 264
Mailing Address - City:CHEROKEE
Mailing Address - State:OK
Mailing Address - Zip Code:73728-4529
Mailing Address - Country:US
Mailing Address - Phone:580-596-3573
Mailing Address - Fax:580-596-3937
Practice Address - Street 1:1504 S GRAND AVE
Practice Address - Street 2:POB 264
Practice Address - City:CHEROKEE
Practice Address - State:OK
Practice Address - Zip Code:73728-4529
Practice Address - Country:US
Practice Address - Phone:580-596-3573
Practice Address - Fax:580-596-3937
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1056152W00000X, 152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Not Answered152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Not Answered152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Not Answered152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Not Answered152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Not Answered152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4494110001Medicare NSC
OKT40589Medicare UPIN