Provider Demographics
NPI:1649221961
Name:OWENS, CHRISTOPHER CHARLES (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:CHARLES
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 1:5380 US HIGHWAY 158
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ADVANCE
Mailing Address - State:NC
Mailing Address - Zip Code:27006-6907
Mailing Address - Country:US
Mailing Address - Phone:336-940-2015
Mailing Address - Fax:336-940-2069
Practice Address - Street 1:5380 US HIGHWAY 158
Practice Address - Street 2:SUITE 100
Practice Address - City:ADVANCE
Practice Address - State:NC
Practice Address - Zip Code:27006-6907
Practice Address - Country:US
Practice Address - Phone:336-940-2015
Practice Address - Fax:336-940-2069
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1835152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89093J6Medicaid
NC2471893CMedicare ID - Type Unspecified
NCU89936Medicare UPIN