Basic Information
Provider Information
NPI: 1275921652
EntityType: 2
ReplacementNPI:  
OrganizationName: OWEN EYE CARE INC
LastName:  
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Credential:  
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Mailing Information
Address1: 620 E 1ST ST
Address2:  
City: NEWBERG
State: OR
PostalCode: 971322912
CountryCode: US
TelephoneNumber: 5038479183
FaxNumber: 9718328578
Practice Location
Address1: 620 E 1ST ST
Address2:  
City: NEWBERG
State: OR
PostalCode: 971322912
CountryCode: US
TelephoneNumber: 5038479183
FaxNumber: 9718328578
Other Information
ProviderEnumerationDate: 01/07/2015
LastUpdateDate: 06/18/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: OWEN
AuthorizedOfficialFirstName: MICHAEL
AuthorizedOfficialMiddleName: R
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 5038479183
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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AuthorizedOfficialCredential:  
NPICertificationDate: 06/18/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
152W00000X  Y193200000X MULTI-SPECIALTY GROUPEye and Vision Services ProvidersOptometrist 

No ID Information.


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