Provider Demographics
NPI:1306884580
Name:OLMSTED, CHRISTINE ANGELENA (OD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:ANGELENA
Last Name:OLMSTED
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2216
Mailing Address - Country:US
Mailing Address - Phone:218-736-7555
Mailing Address - Fax:218-739-6586
Practice Address - Street 1:117 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2216
Practice Address - Country:US
Practice Address - Phone:218-736-7555
Practice Address - Fax:218-739-6586
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2265152W00000X
WI2322152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1010284OtherPREFERRED ONE
MN2200945OtherMEDICA
MN410049145OtherRAILROAD MEDICARE
MN849523800Medicaid
ND60610Medicaid
MN62123OLOtherBLUE CROSS BLUE SHIELD
MN2200945OtherMEDICA
MN849523800Medicaid
MN410000842Medicare ID - Type Unspecified