Provider Demographics
NPI:1114908860
Name:OLSON, THOMAS HUNTER (DPM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:HUNTER
Last Name:OLSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 ARDEN LANE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3257
Mailing Address - Country:US
Mailing Address - Phone:803-366-9440
Mailing Address - Fax:803-366-7704
Practice Address - Street 1:724 ARDEN LANE
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3257
Practice Address - Country:US
Practice Address - Phone:803-366-9440
Practice Address - Fax:803-366-7704
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC604213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPD6041Medicaid
SCPD6041Medicaid
SCAA4777Medicare UPIN
SC6326600001Medicare NSC