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General NPI Number Information
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NPI Number | 1841078946
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Entity Type | Organization
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Legal Business Name | OLYSIS, LLC
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Dates
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Enumeration Date | 09/19/2023
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Last Update Date | 03/15/2025
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Provider Practice Location Address
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Address Line | 509 E BYRON NELSON BLVD STE C
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City | ROANOKE
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State | TX
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Zip | 76262-6183
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Country | US
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Telephone | 682-593-1442
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Fax |
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Provider Business Mailing Address
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Address Line | 509 E BYRON NELSON BLVD STE C
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City | ROANOKE
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State | TX
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Zip | 76262-6183
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Country | US
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Telephone | 682-593-1442
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Fax |
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Authorized Official
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Title or Position | OWNER / ELECTROLOGIST
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Name | MS. JAMIE JOHNSON
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Credential | CPE
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Telephone | 214-326-5721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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