Healthcare Provider Details

I. General information

NPI: 1679550396
Provider Name (Legal Business Name): NICHOLE AMINA OLSON OD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USNH YOKOSUKA JAPAN PSC 475 BOX 1
FPO AP
96350
US

IV. Provider business mailing address

PSC 477 BOX 2
APO FP
96306
US

V. Phone/Fax

Practice location:
  • Phone: 01181467634783
  • Fax:
Mailing address:
  • Phone: 01181467634783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618001294
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: