Provider Demographics
NPI:1124077276
Name:OWENS, RICHARD E (OD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
Last Name:OWENS
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:PO BOX 1237
Mailing Address - Street 2:
Mailing Address - City:CHERAW
Mailing Address - State:SC
Mailing Address - Zip Code:29520-1237
Mailing Address - Country:US
Mailing Address - Phone:843-537-7711
Mailing Address - Fax:843-537-9582
Practice Address - Street 1:705 CHESTERFIELD RD.
Practice Address - Street 2:
Practice Address - City:CHERAW
Practice Address - State:SC
Practice Address - Zip Code:29520-1237
Practice Address - Country:US
Practice Address - Phone:843-537-7711
Practice Address - Fax:843-537-9582
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC616152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDO6161Medicaid
SCDO6161Medicaid