Provider Demographics
NPI:1215667134
Name:THEIS, OLIVIA JANE
Entity type:Individual
Prefix:MISS
First Name:OLIVIA
Middle Name:JANE
Last Name:THEIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:405 W GREENLAWN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-2889
Mailing Address - Country:US
Mailing Address - Phone:517-657-2638
Mailing Address - Fax:248-712-4381
Practice Address - Street 1:405 W GREENLAWN AVE STE 200
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-2889
Practice Address - Country:US
Practice Address - Phone:517-657-2638
Practice Address - Fax:248-712-4381
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist