Provider Demographics
NPI:1861674236
Name:OWENS OPTOMETRICS
Entity Type:Organization
Organization Name:OWENS OPTOMETRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:K
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:CPOA
Authorized Official - Phone:717-354-2251
Mailing Address - Street 1:654 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17557-1410
Mailing Address - Country:US
Mailing Address - Phone:717-354-2251
Mailing Address - Fax:717-355-2138
Practice Address - Street 1:654 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:17557-1410
Practice Address - Country:US
Practice Address - Phone:717-354-2251
Practice Address - Fax:717-355-2138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001333152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT29979Medicare UPIN
PA4555000001Medicare NSC
PA051632Medicare PIN