Provider Demographics
NPI:1285709279
Name:OWEN, JAMES E (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
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 1:12606 HOLLY ROAD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439
Mailing Address - Country:US
Mailing Address - Phone:810-694-3652
Mailing Address - Fax:810-694-0963
Practice Address - Street 1:12606 HOLLY ROAD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439
Practice Address - Country:US
Practice Address - Phone:810-694-3652
Practice Address - Fax:810-694-0963
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002226152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0991485OtherHEALTH PLUS OF MI
MI5005725Medicaid
MI900B563850OtherBCBS
MIB56385001Medicare PIN
MI5005725Medicaid
MI0633280001Medicare NSC