Provider Demographics
NPI:1902420961
Name:EWONCE, AMBER (OD)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:
Last Name:EWONCE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 KOHLEEN DR
Mailing Address - Street 2:
Mailing Address - City:MC KEES ROCKS
Mailing Address - State:PA
Mailing Address - Zip Code:15136-1059
Mailing Address - Country:US
Mailing Address - Phone:412-605-4277
Mailing Address - Fax:
Practice Address - Street 1:1501 STATE AVE
Practice Address - Street 2:
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-2051
Practice Address - Country:US
Practice Address - Phone:412-264-8830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003659152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist