Provider Demographics
NPI:1629328950
Name:OWEN, GEORGE GREGOR (LDO, FNAO)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:GREGOR
Last Name:OWEN
Suffix:
Gender:M
Credentials:LDO, FNAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4209 LASSITER MILL RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-5794
Mailing Address - Country:US
Mailing Address - Phone:919-783-5863
Mailing Address - Fax:919-783-5864
Practice Address - Street 1:4209 LASSITER MILL RD
Practice Address - Street 2:SUITE 110
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5794
Practice Address - Country:US
Practice Address - Phone:919-783-5863
Practice Address - Fax:919-783-5864
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC 1860156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician