Healthcare Provider Details

I. General information

NPI: 1053313288
Provider Name (Legal Business Name): DOUGLAS GERALD OWEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2704 OLD ROSEBUD RD
LEXINGTON KY
40509-8627
US

IV. Provider business mailing address

609 IMPERIAL LAKES RD
RICHMOND KY
40475-8075
US

V. Phone/Fax

Practice location:
  • Phone: 859-263-4361
  • Fax:
Mailing address:
  • Phone: 859-200-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number23349
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number23349
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: