Healthcare Provider Details

I. General information

NPI: 1285663260
Provider Name (Legal Business Name): JENNIFER OLGA OLESHAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1687 HWY 395 UNIT 2
MINDEN NV
89423-9999
US

IV. Provider business mailing address

1687 HWY 395 UNIT 2
MINDEN NV
89423-0000
US

V. Phone/Fax

Practice location:
  • Phone: 775-783-8866
  • Fax: 775-783-1959
Mailing address:
  • Phone: 775-783-8866
  • Fax: 775-783-1959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number284
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: