Provider Demographics
NPI:1215981139
Name:OLMSTEAD, ALLEN DENNIS (OD)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:DENNIS
Last Name:OLMSTEAD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 LANSING ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813
Mailing Address - Country:US
Mailing Address - Phone:517-543-2020
Mailing Address - Fax:517-543-0311
Practice Address - Street 1:123 LANSING ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813
Practice Address - Country:US
Practice Address - Phone:517-543-2020
Practice Address - Fax:517-543-0311
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002705152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AO002705OtherBCBS OF MI
MI2200025OtherPHP OF MID MICHIGAN
410029436OtherMEDICARE RAILROAD
410029436OtherRAILROAD MEDICARE
U21809Medicare UPIN
410029436OtherRAILROAD MEDICARE
MI2200025OtherPHP OF MID MICHIGAN