Healthcare Provider Details

I. General information

NPI: 1619205242
Provider Name (Legal Business Name): JANE OLSON MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8440 BLUEBONNET BLVD SUITE B
BATON ROUGE LA
70810-2978
US

IV. Provider business mailing address

8440 BLUEBONNET BLVD SUITE B
BATON ROUGE LA
70810-2978
US

V. Phone/Fax

Practice location:
  • Phone: 225-766-0005
  • Fax: 225-766-0131
Mailing address:
  • Phone: 225-766-0005
  • Fax: 225-766-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberMD201863
License Number StateLA

VIII. Authorized Official

Name: DR. JANE OLSON
Title or Position: OCULOFACIAL SURGEON
Credential:
Phone: 225-766-0005