MEDICARE: DR. PAUL J. OLSOVSKY O.D.

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	152W00000X	Optometrist	3252AT	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700112125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL J. OLSOVSKY O.D.

Provider Business Mailing Address
First Line	:	8316 N LOMBARD ST
Second Line	:	UNIT #404
City	:	PORTLAND
State	:	OR
Zip	:	97203-3727
Country	:	US
Telephone Number	:	503-481-3343
Fax Number	:

Provider Business Practice Location Address
First Line	:	625 BLACK LAKE BLVD SW STE 110
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-8603
Country	:	US
Telephone Number	:	360-357-2542
Fax Number	:

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

Provider Enumeration Date	:	10/19/2009
Last Update Date	:	07/21/2022

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