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NPI Code Detail

MEDICARE: NILS W. OHLSEN O.D.

MEDICARE: NILS W. OHLSEN O.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
1152W00000XOptometristOPT-002651AZ
2152W00000XOptometristOEG004078PA
3152W00000XOptometristODP-100587ID
4152W00000XOptometristOPT-OPT-LIC-4613MT
5152W00000XOptometrist1079NH
6152W00000XOptometrist3589WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457358657
Entity Type Code : Individual
Provider Name (Legal Business Name) : NILS W. OHLSEN O.D.
Provider Business Mailing Address
First Line : PO BOX 581
Second Line :
City : LIBERTY LAKE
State : WA
Zip : 99019-0581
Country : US
Telephone Number : 509-928-6922
Fax Number :
Provider Business Practice Location Address
First Line : 15727 E BROADWAY AVE
Second Line :
City : SPOKANE VALLEY
State : WA
Zip : 99037-9544
Country : US
Telephone Number : 509-926-0667
Fax Number : 509-922-9849
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2005
Last Update Date : 10/09/2023

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