Healthcare Provider Details

I. General information

NPI: 1093529497
Provider Name (Legal Business Name): EVAN OLSEN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 RUE LOUIS XIV
LAFAYETTE LA
70508-5736
US

IV. Provider business mailing address

140 S POINT DR
HOUMA LA
70360-7399
US

V. Phone/Fax

Practice location:
  • Phone: 337-981-2393
  • Fax: 337-981-9470
Mailing address:
  • Phone: 985-688-0112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2090-037AT
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: