Provider Demographics
NPI:1508937160
Name:EWALD, DOROTHY ANNE (OD)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:ANNE
Last Name:EWALD
Suffix:
Gender:F
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:METROVISION OPTICAL
Mailing Address - Street 2:216A FULTON AVENUE
Mailing Address - City:HEMPSTEAD,
Mailing Address - State:NY
Mailing Address - Zip Code:11550
Mailing Address - Country:US
Mailing Address - Phone:516-538-3200
Mailing Address - Fax:
Practice Address - Street 1:7051 PARSONS BLVD
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-3049
Practice Address - Country:US
Practice Address - Phone:718-380-7788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT005314152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01447103Medicaid
NY01447103Medicaid