Provider Demographics
NPI:1770576514
Name:ERWIN, DAVID ANDREW (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ANDREW
Last Name:ERWIN
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 1:535 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-1210
Mailing Address - Country:US
Mailing Address - Phone:740-622-2270
Mailing Address - Fax:740-622-4376
Practice Address - Street 1:535 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-1210
Practice Address - Country:US
Practice Address - Phone:740-622-2270
Practice Address - Fax:740-622-4376
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3344 T916152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0279500001Medicare NSC
OH0458702Medicare PIN
OH0458702Medicare ID - Type Unspecified