Provider Demographics
NPI:1588769848
Name:OWEN, DAN EUGENE (OD)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:EUGENE
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 1:5301 HIGHWAY 153
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4966
Mailing Address - Country:US
Mailing Address - Phone:423-877-9990
Mailing Address - Fax:423-875-9952
Practice Address - Street 1:5301 HIGHWAY 153
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4966
Practice Address - Country:US
Practice Address - Phone:423-877-9990
Practice Address - Fax:423-875-9952
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT 001596152W00000X
TNOD 0000000546152W00000X
SC1494152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA491456241AMedicaid
GA41ZCFKPMedicare ID - Type Unspecified
T61126Medicare UPIN