Provider Demographics
NPI:1417961806
Name:OWENS, DOUGLAS RAY (OD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:RAY
Last Name:OWENS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 E PARKER RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-5112
Mailing Address - Country:US
Mailing Address - Phone:828-433-1000
Mailing Address - Fax:828-433-6274
Practice Address - Street 1:640 OAK ST
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-3470
Practice Address - Country:US
Practice Address - Phone:828-245-5550
Practice Address - Fax:828-245-0551
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1106152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC64653OtherBLUE CROSS BLUE SHIELD NC
NC8964653Medicaid
NC246407FMedicare PIN
T64943Medicare UPIN
NC246407DMedicare PIN
NC246407HMedicare PIN
NC64653OtherBLUE CROSS BLUE SHIELD NC