Provider Demographics
NPI:1164774568
Name:OLSON EYE CARE PLC
Entity Type:Organization
Organization Name:OLSON EYE CARE PLC
Other - Org Name:VISION SPECIALISTS OF COUNCIL BLUFFS PLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:712-256-1111
Mailing Address - Street 1:320 MCKENZIE AVE
Mailing Address - Street 2:STE 206
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-1002
Mailing Address - Country:US
Mailing Address - Phone:712-256-1111
Mailing Address - Fax:712-256-1549
Practice Address - Street 1:320 MCKENZIE AVE
Practice Address - Street 2:STE 206
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-1002
Practice Address - Country:US
Practice Address - Phone:712-256-1111
Practice Address - Fax:712-256-1549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002496152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty