Provider Demographics
NPI:1922737352
Name:OWENS, BRANDON LEE (DO)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:LEE
Last Name:OWENS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BYPASS N
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40342-9462
Mailing Address - Country:US
Mailing Address - Phone:502-839-8626
Mailing Address - Fax:502-839-8706
Practice Address - Street 1:1000 BYPASS N
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:KY
Practice Address - Zip Code:40342-9462
Practice Address - Country:US
Practice Address - Phone:502-839-8626
Practice Address - Fax:502-839-8706
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-110142156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician