Provider Demographics
NPI:1508947029
Name:OWENS, KIMBERLY SUE (OD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:SUE
Last Name:OWENS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:6113 SAW MILL DR
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-6559
Mailing Address - Country:US
Mailing Address - Phone:317-770-1633
Mailing Address - Fax:317-770-0932
Practice Address - Street 1:13230 HARRELL PKWY STE 300
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-3319
Practice Address - Country:US
Practice Address - Phone:317-770-1633
Practice Address - Fax:317-770-0932
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT002533152W00000X
IN18002577152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U37283Medicare UPIN