Provider Demographics
NPI:1134672751
Name:OWENS, HALEY (OD)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:OWENS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:DEER LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59722-1910
Mailing Address - Country:US
Mailing Address - Phone:406-498-8404
Mailing Address - Fax:
Practice Address - Street 1:410 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:DEER LODGE
Practice Address - State:MT
Practice Address - Zip Code:59722-1910
Practice Address - Country:US
Practice Address - Phone:406-498-8404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-31
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTOPT-OPT-LIC-2789152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist