MEDICARE: RICHARD L OLSON P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA14670	CA

General Provider Information

NPI Number	:	1194840603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD L OLSON P.A.

Provider Business Mailing Address
First Line	:	5080 SPECTRUM DR
Second Line	:	SUITE 1200 WEST
City	:	ADDISON
State	:	TX
Zip	:	75001-4648
Country	:	US
Telephone Number	:	972-364-8000
Fax Number	:	214-775-4502

Provider Business Practice Location Address
First Line	:	2121 S TOWNE CENTRE PL
Second Line	:	#100
City	:	ANAHEIM
State	:	CA
Zip	:	92806-6122
Country	:	US
Telephone Number	:	615-778-4066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	10/07/2009

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