Provider Demographics
NPI:1053313288
Name:OWEN, DOUGLAS GERALD (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:GERALD
Last Name:OWEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 IMPERIAL LAKES RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8075
Mailing Address - Country:US
Mailing Address - Phone:859-200-1900
Mailing Address - Fax:
Practice Address - Street 1:2704 OLD ROSEBUD RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-8627
Practice Address - Country:US
Practice Address - Phone:859-263-4361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23349174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2806548Medicaid
KY174400000Medicaid
KY64233497Medicaid
KYC69283Medicare UPIN
OH2806548Medicaid
KY0345312Medicare PIN
KY1636601Medicare PIN
KY64233497Medicaid
OH4226311Medicare PIN
KY1636501Medicare PIN