Healthcare Provider Details

I. General information

NPI: 1700872892
Provider Name (Legal Business Name): BRYAN EWING ALLF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 3RD AVE
GASTONIA NC
28052-4317
US

IV. Provider business mailing address

200 E 2ND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 704-874-3300
  • Fax:
Mailing address:
  • Phone: 704-874-1907
  • Fax: 704-865-4614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number32919
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: