Provider Demographics
NPI:1215119789
Name:OLSON EYE CARE LLC
Entity type:Organization
Organization Name:OLSON EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:608-833-0062
Mailing Address - Street 1:537 E MAIN ST
Mailing Address - Street 2:PO BOX 350
Mailing Address - City:WAUPUN
Mailing Address - State:WI
Mailing Address - Zip Code:53963-2162
Mailing Address - Country:US
Mailing Address - Phone:920-324-3501
Mailing Address - Fax:920-324-3380
Practice Address - Street 1:537 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WAUPUN
Practice Address - State:WI
Practice Address - Zip Code:53963-2162
Practice Address - Country:US
Practice Address - Phone:920-324-3501
Practice Address - Fax:920-324-3380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI 2773152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI6209550001Medicare NSC
WIU77239Medicare UPIN