Provider Demographics
NPI:1831164599
Name:OWENS, MARK L (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:OWENS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7009
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-7009
Mailing Address - Country:US
Mailing Address - Phone:270-443-9955
Mailing Address - Fax:270-442-1469
Practice Address - Street 1:1748 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-2706
Practice Address - Country:US
Practice Address - Phone:270-443-9955
Practice Address - Fax:270-442-1469
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY941DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY277290OtherHEALTHLINK
KY5789371OtherAETNA
KYT54726OtherBLUEGRASS FAMILY HEALTH
KY77009413Medicaid
KY000000199246OtherBLUE CROSS BLUE SHIELD
KY000000199246OtherBLUE CROSS BLUE SHIELD
KY000000199246OtherBLUE CROSS BLUE SHIELD
KYT54726OtherBLUEGRASS FAMILY HEALTH
KYT54726Medicare UPIN