Healthcare Provider Details

I. General information

NPI: 1497873129
Provider Name (Legal Business Name): BRUCE A. OLSON D.P.M., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 SAVIERS RD SUITE 5
OXNARD CA
93033-3650
US

IV. Provider business mailing address

2035 SAVIERS RD SUITE 5
OXNARD CA
93033-3650
US

V. Phone/Fax

Practice location:
  • Phone: 805-486-8710
  • Fax: 805-486-2856
Mailing address:
  • Phone: 805-486-8710
  • Fax: 805-486-2856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberE1206
License Number StateCA

VIII. Authorized Official

Name: DR. BRUCE ALTON OLSON
Title or Position: PODIATRIST
Credential: D.P.M.
Phone: 805-486-8710