Healthcare Provider Details

I. General information

NPI: 1275921652
Provider Name (Legal Business Name): OWEN EYE CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 E 1ST ST
NEWBERG OR
97132-2912
US

IV. Provider business mailing address

620 E 1ST ST
NEWBERG OR
97132-2912
US

V. Phone/Fax

Practice location:
  • Phone: 503-847-9183
  • Fax: 971-832-8578
Mailing address:
  • Phone: 503-847-9183
  • Fax: 971-832-8578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL R OWEN
Title or Position: OWNER
Credential:
Phone: 503-847-9183