Basic Information
| Provider Information | |||||||||
| NPI: | 1952405466 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEWTH | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1725 E. KAEL ST. | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852032161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806415555 | ||||||||
| FaxNumber: | 4806542020 | ||||||||
| Practice Location | |||||||||
| Address1: | 6145 N 35TH AVE | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850171940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029736567 | ||||||||
| FaxNumber: | 6029736569 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 01/27/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 0167 | AZ | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | AZ0901210 | 01 | AZ | BCBS | OTHER | 035156 | 05 | AZ | MEDICAID | MN0633328 | 01 | DEA | OTHER |