Provider Demographics
NPI:1861083412
Name:COTTON, OLIVIA ANNE (OD)
Entity type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:ANNE
Last Name:COTTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:ANNE
Other - Last Name:DEWAARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:617 3RD ST SE
Mailing Address - Street 2:
Mailing Address - City:WAGNER
Mailing Address - State:SD
Mailing Address - Zip Code:57380-9566
Mailing Address - Country:US
Mailing Address - Phone:605-680-0914
Mailing Address - Fax:
Practice Address - Street 1:118 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PARKSTON
Practice Address - State:SD
Practice Address - Zip Code:57366-2075
Practice Address - Country:US
Practice Address - Phone:605-928-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD769152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty