Basic Information
| Provider Information | |||||||||
| NPI: | 1922070028 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OWEN | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | ELEFTHERIOU | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OPTOMETRIST OD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ELEFTHERIOU | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | LYNN | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | OD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9806 ROCKINGHAM DR | ||||||||
| Address2: | |||||||||
| City: | PEYTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 808316440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193223557 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1130 LAKE PLAZA DR | ||||||||
| Address2: | STE 230 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809063594 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7192193819 | ||||||||
| FaxNumber: | 7192190411 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2006 | ||||||||
| LastUpdateDate: | 11/20/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2505 | CO | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.