Provider Demographics
NPI:1699749697
Name:OLSON, DENNIS L (OD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:L
Last Name:OLSON
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 1:5710 CAHALAN AVE
Mailing Address - Street 2:BLDG 2
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3010
Mailing Address - Country:US
Mailing Address - Phone:408-229-2020
Mailing Address - Fax:408-227-5056
Practice Address - Street 1:5710 CAHALAN AVE
Practice Address - Street 2:BLDG 2
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3010
Practice Address - Country:US
Practice Address - Phone:408-229-2020
Practice Address - Fax:408-227-5056
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 05920T152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0059200Medicaid
T10169Medicare UPIN