Provider Demographics
NPI:1962758201
Name:OWEN, DANIEL D (OD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:D
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 1:942 W SHAWNEE ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-3511
Mailing Address - Country:US
Mailing Address - Phone:918-687-0772
Mailing Address - Fax:918-687-0788
Practice Address - Street 1:942 W SHAWNEE ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-3511
Practice Address - Country:US
Practice Address - Phone:918-687-0772
Practice Address - Fax:918-687-0788
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2745152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200441540AMedicaid