Healthcare Provider Details

I. General information

NPI: 1821597519
Provider Name (Legal Business Name): JAREN OLSEN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2018
Last Update Date: 09/14/2024
Certification Date: 09/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3508 S 25TH E
IDAHO FALLS ID
83404-5027
US

IV. Provider business mailing address

3508 S 25TH E
IDAHO FALLS ID
83404-5027
US

V. Phone/Fax

Practice location:
  • Phone: 208-557-3222
  • Fax: 208-561-8692
Mailing address:
  • Phone: 208-557-3222
  • Fax: 208-561-8692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODP-100631
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberODP-100631
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: