MEDICARE: DR. RANDALL R. OLSEN AU.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231HA2400X	Assistive Technology Practitioner Audiologist	A00215	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0583271	OTHER	OH	MEDICARE #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000133435	OTHER	OH	AUDIOLOGY

General Provider Information

NPI Number	:	1144203530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDALL R. OLSEN AU.D

Provider Business Mailing Address
First Line	:	5267 PEARL RD
Second Line	:
City	:	PARMA
State	:	OH
Zip	:	44129-1550
Country	:	US
Telephone Number	:	216-485-5767
Fax Number	:	216-485-5768

Provider Business Practice Location Address
First Line	:	5267 PEARL RD
Second Line	:
City	:	PARMA
State	:	OH
Zip	:	44129-1550
Country	:	US
Telephone Number	:	216-485-5767
Fax Number	:	216-485-5768

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	07/31/2008

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