Basic Information
| Provider Information | |||||||||
| NPI: | 1275778748 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | OWEN | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | DIANE | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11103 WEST AVE | ||||||||
| Address2: | STE 6 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782131338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105246803 | ||||||||
| FaxNumber: | 2105246587 | ||||||||
| Practice Location | |||||||||
| Address1: | 545 S BROADWAY | ||||||||
| Address2: | SUITE 500 B-1 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802094067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7205704338 | ||||||||
| FaxNumber: | 7205703662 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2008 | ||||||||
| LastUpdateDate: | 12/11/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2690 | CO | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.