Provider Demographics
NPI:1063576171
Name:OLSON, ARLESE CHARLETTE (OD)
Entity type:Individual
Prefix:
First Name:ARLESE
Middle Name:CHARLETTE
Last Name:OLSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ARLESE
Other - Middle Name:CHARLETTE
Other - Last Name:SIVILS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:229 FRENCHMANS CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-1810
Mailing Address - Country:US
Mailing Address - Phone:863-676-0911
Mailing Address - Fax:863-676-0715
Practice Address - Street 1:762 EAGLE RIDGE DR
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33859-4740
Practice Address - Country:US
Practice Address - Phone:863-676-0911
Practice Address - Fax:863-676-0715
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2856152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU57672Medicare UPIN