MEDICARE: KATIE E OLINECK OD

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	152W00000X	Optometrist	2876	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	644S6OL	OTHER	MN	BLUE CROSS/BLUE SHIELD
2	HP37235	OTHER	MN	HEALTH PARTNERS
3	22-01181	OTHER	MN	MEDICA PRIMARY
4	331J9OL	OTHER	MN	BLUE CROSS/BLUE SHIELD
5	171040	OTHER	MN	UCARE SRS AND MN
6	935301032789	OTHER	MN	PREFERRED ONE
7	964111032789	OTHER	MN	PREFERRED ONE
8	219596	OTHER	MN	COLE MANAGED VISION
9	22-01908	OTHER	MN	MEDICA CHOICE
10	22-01907	OTHER	MN	SELECT CARE
11	22-01908	OTHER	MN	SELECT CARE
12	1808779	OTHER	MN	ARAZ/AMERICA'S PPO
13	22-01907	OTHER	MN	MEDICA CHOICE

General Provider Information

NPI Number	:	1669476610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE E OLINECK OD

Provider Business Mailing Address
First Line	:	5200 DOUGLAS DR N
Second Line	:
City	:	CRYSTAL
State	:	MN
Zip	:	55429-3104
Country	:	US
Telephone Number	:	763-537-3213
Fax Number	:	763-537-6732

Provider Business Practice Location Address
First Line	:	13645 GROVE DR N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55311
Country	:	US
Telephone Number	:	763-420-8030
Fax Number	:	763-420-9842

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	07/08/2007

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