Healthcare Provider Details

I. General information

NPI: 1619979549
Provider Name (Legal Business Name): GERALD E OLSON O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 LINCOLN WAY STE 240
WHITE OAK PA
15131-2419
US

IV. Provider business mailing address

506 ATHENA DR
DELMONT PA
15626-1005
US

V. Phone/Fax

Practice location:
  • Phone: 412-673-1243
  • Fax: 412-673-1129
Mailing address:
  • Phone: 724-468-6869
  • Fax: 724-468-6207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG00748
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: