Provider Demographics
NPI:1750614426
Name:OWEN, MICHAEL R (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
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 1:620 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-2912
Mailing Address - Country:US
Mailing Address - Phone:503-847-9183
Mailing Address - Fax:971-832-8578
Practice Address - Street 1:620 E 1ST ST
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-2912
Practice Address - Country:US
Practice Address - Phone:503-847-9183
Practice Address - Fax:971-832-8578
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3316ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist