Provider Demographics
NPI:1982656559
Name:EWERS, GANHAN T (OD)
Entity Type:Individual
Prefix:DR
First Name:GANHAN
Middle Name:T
Last Name:EWERS
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:9795 CROSSPOINT BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3354
Mailing Address - Country:US
Mailing Address - Phone:317-254-6480
Mailing Address - Fax:317-259-8609
Practice Address - Street 1:980 AVERITT RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-9540
Practice Address - Country:US
Practice Address - Phone:317-881-4143
Practice Address - Fax:317-881-5072
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN18002777152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ1942009Medicare PIN
ININ1943012Medicare PIN
INM400041032Medicare PIN