Provider Demographics
NPI:1679671531
Name:OWEN, NATHAN WAYNE (OD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:WAYNE
Last Name:OWEN
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 1:2720 S QUILLAN ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-2404
Mailing Address - Country:US
Mailing Address - Phone:509-585-8314
Mailing Address - Fax:509-585-9653
Practice Address - Street 1:2720 S QUILLAN ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99337-2404
Practice Address - Country:US
Practice Address - Phone:509-585-8314
Practice Address - Fax:509-585-9653
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60073002152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist