Healthcare Provider Details

I. General information

NPI: 1558428359
Provider Name (Legal Business Name): DANIEL A EWEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2580 BYPASS ROAD
WINCHESTER KY
40392
US

IV. Provider business mailing address

PO BOX 4277 2580 BYPASS ROAD
WINCHESTER KY
40392-4277
US

V. Phone/Fax

Practice location:
  • Phone: 859-745-3060
  • Fax: 859-745-0885
Mailing address:
  • Phone: 859-745-3060
  • Fax: 859-745-0885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number25190
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: