Individual
JORDAN SCOTT EWERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2109 N KICKAPOO AVE, SHAWNEE, OK 74804-2732
(405) 275-2020
(405) 275-4129
Mailing address
2109 N KICKAPOO AVE, SHAWNEE, OK 74804-2732
(405) 275-2020
(405) 275-4129
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2728
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200463520A
—
OK
Enumeration date
07/24/2012
Last updated
10/19/2016
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