Provider Demographics
NPI:1992987366
Name:SCOTT T. OLSON
Entity type:Organization
Organization Name:SCOTT T. OLSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:T
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-375-2020
Mailing Address - Street 1:302 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:MN
Mailing Address - Zip Code:56081-1724
Mailing Address - Country:US
Mailing Address - Phone:507-375-2020
Mailing Address - Fax:
Practice Address - Street 1:302 1ST AVE S
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MN
Practice Address - Zip Code:56081-1724
Practice Address - Country:US
Practice Address - Phone:507-375-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN956483200Medicaid
MNC04789Medicare PIN
MN6050530001Medicare NSC
MN956483200Medicaid
MNDO1937Medicare PIN