Healthcare Provider Details

I. General information

NPI: 1871599068
Provider Name (Legal Business Name): ROBERT L OWENS II OD, FAAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date: 03/16/2006
Reactivation Date: 06/27/2006

III. Provider practice location address

654 E MAIN ST
NEW HOLLAND PA
17557-1410
US

IV. Provider business mailing address

654 E MAIN ST
NEW HOLLAND PA
17557-1410
US

V. Phone/Fax

Practice location:
  • Phone: 717-354-2251
  • Fax: 717-355-2138
Mailing address:
  • Phone: 717-354-2251
  • Fax: 717-355-2138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG001333
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: