Provider Demographics
NPI:1225020472
Name:OLSON, BRUCE A (DPM)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:A
Last Name:OLSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2035 SAVIERS RD
Mailing Address - Street 2:STE 5
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-3650
Mailing Address - Country:US
Mailing Address - Phone:805-486-8710
Mailing Address - Fax:805-486-2856
Practice Address - Street 1:2035 SAVIERS RD
Practice Address - Street 2:STE 5
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-3650
Practice Address - Country:US
Practice Address - Phone:805-486-8710
Practice Address - Fax:805-486-2856
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE1206213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0883610001OtherCIGNA MEDICARE
CA000E120607Medicaid
P00194968OtherRAILROAD MEDICARE
CA000E120607Medicaid
P00194968OtherRAILROAD MEDICARE
CA0883610001OtherCIGNA MEDICARE