Provider Demographics
NPI:1053165944
Name:OWENS, ELAINA LARRAY-WEBB (OD)
Entity type:Individual
Prefix:
First Name:ELAINA
Middle Name:LARRAY-WEBB
Last Name:OWENS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 SIAM RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-5435
Mailing Address - Country:US
Mailing Address - Phone:423-721-2214
Mailing Address - Fax:
Practice Address - Street 1:2003 N EASTMAN RD STE 34
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4636
Practice Address - Country:US
Practice Address - Phone:423-408-6134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3867152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist