Provider Demographics
NPI:1538492459
Name:AYCOCK, OWEN E (CPO)
Entity Type:Individual
Prefix:MR
First Name:OWEN
Middle Name:E
Last Name:AYCOCK
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 VICTORIA RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4419
Mailing Address - Country:US
Mailing Address - Phone:828-254-6305
Mailing Address - Fax:828-254-6110
Practice Address - Street 1:75 VICTORIA RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4419
Practice Address - Country:US
Practice Address - Phone:828-254-6305
Practice Address - Fax:828-254-6110
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier