Provider Demographics
NPI:1578948212
Name:EWING, DANIEL LUKE (OD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:LUKE
Last Name:EWING
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E KOLSTAD ST
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-2352
Mailing Address - Country:US
Mailing Address - Phone:903-723-3250
Mailing Address - Fax:903-723-5550
Practice Address - Street 1:800 N BEATON ST
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-3149
Practice Address - Country:US
Practice Address - Phone:903-874-0005
Practice Address - Fax:903-874-0009
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8761T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX351627001Medicaid