Provider Demographics
NPI:1104156538
Name:OLSON, ERIC WAYNE
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:WAYNE
Last Name:OLSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:95006-9724
Mailing Address - Country:US
Mailing Address - Phone:831-419-9240
Mailing Address - Fax:
Practice Address - Street 1:32 E ALISAL ST
Practice Address - Street 2:SUITE 211
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3404
Practice Address - Country:US
Practice Address - Phone:408-379-3790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator