Provider Demographics
NPI:1902069305
Name:OLSWING, LESLEY K (OD)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:K
Last Name:OLSWING
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LESLEY
Other - Middle Name:K
Other - Last Name:HORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1215 DUFF AVENUE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-3014
Mailing Address - Country:US
Mailing Address - Phone:515-239-3020
Mailing Address - Fax:515-239-3025
Practice Address - Street 1:3500 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 1001
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-3014
Practice Address - Country:US
Practice Address - Phone:515-239-3020
Practice Address - Fax:515-239-3025
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08211152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1902069305Medicaid
MO4637030002Medicare NSC
MO4637030001Medicare NSC
MO168600001Medicare PIN
MO4637030003Medicare NSC
MO1902069305Medicaid
MOP00637669Medicare PIN
MOCK8054Medicare PIN