Healthcare Provider Details

I. General information

NPI: 1871860130
Provider Name (Legal Business Name): OLSON OPTICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 04/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 1ST AVE S
SAINT JAMES MN
56081-1724
US

IV. Provider business mailing address

302 1ST AVE S
SAINT JAMES MN
56081-1724
US

V. Phone/Fax

Practice location:
  • Phone: 507-375-2020
  • Fax:
Mailing address:
  • Phone: 507-375-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT T OLSON
Title or Position: PRESIDENT
Credential:
Phone: 507-375-2020