Provider Demographics
NPI:1083819049
Name:EWING OPTICAL INC.
Entity Type:Organization
Organization Name:EWING OPTICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:HOUSTON
Authorized Official - Last Name:EWING
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:561-798-0244
Mailing Address - Street 1:11388 OKEECHOBEE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-8705
Mailing Address - Country:US
Mailing Address - Phone:561-798-0244
Mailing Address - Fax:561-793-0082
Practice Address - Street 1:11388 OKEECHOBEE BLVD
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-8705
Practice Address - Country:US
Practice Address - Phone:561-798-0244
Practice Address - Fax:561-793-0082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO1945156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0852180001Medicare ID - Type Unspecified