Healthcare Provider Details

I. General information

NPI: 1235661851
Provider Name (Legal Business Name): CASSANDRA R OLSON WILLIAMS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CASSANDRA R OLSON

II. Dates (important events)

Enumeration Date: 04/02/2017
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 PINION DR
USAF ACADEMY CO
80840-2502
US

IV. Provider business mailing address

14530 NW MILITARY HWY
SHAVANO PARK TX
78231-1622
US

V. Phone/Fax

Practice location:
  • Phone: 719-333-5020
  • Fax: 719-333-1249
Mailing address:
  • Phone: 210-450-6620
  • Fax: 210-450-6621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberT0588
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: