Provider Demographics
NPI:1467444026
Name:OWENS, KIMBERLY A (OD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
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 1:1602 E ROBINSON AVE
Mailing Address - Street 2:STE. M
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-5991
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1602 E ROBINSON AVE
Practice Address - Street 2:STE. M
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5991
Practice Address - Country:US
Practice Address - Phone:479-750-9996
Practice Address - Fax:479-750-9922
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2520152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154495722Medicaid
ARU81920Medicare UPIN
AR49786Medicare ID - Type Unspecified