MEDICARE: DR. JONATHAN DANIEL OWENS OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2148	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336142793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN DANIEL OWENS OD

Provider Business Mailing Address
First Line	:	PO BOX 544
Second Line	:
City	:	EDWARDS
State	:	CO
Zip	:	81632
Country	:	US
Telephone Number	:	970-926-8474
Fax Number	:	970-926-3634

Provider Business Practice Location Address
First Line	:	1140 EDWARDS VILLAGE BLVD.
Second Line	:	B-206
City	:	EDWARDS
State	:	CO
Zip	:	81632
Country	:	US
Telephone Number	:	970-926-8474
Fax Number	:	970-926-3634

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	05/21/2012

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