Provider Demographics
NPI:1346037751
Name:OWENS, BRANT
Entity type:Individual
Prefix:
First Name:BRANT
Middle Name:
Last Name:OWENS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6131 E SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3732
Mailing Address - Country:US
Mailing Address - Phone:480-980-7174
Mailing Address - Fax:480-985-9082
Practice Address - Street 1:6131 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3732
Practice Address - Country:US
Practice Address - Phone:480-980-7174
Practice Address - Fax:480-985-9082
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ000445156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician