Provider Demographics
NPI:1225721483
Name:OLSON, STEVE BLAKE JR (ABO-AC, NCLE-AC)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:BLAKE
Last Name:OLSON
Suffix:JR
Gender:M
Credentials:ABO-AC, NCLE-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 MANHATTAN ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89512-3030
Mailing Address - Country:US
Mailing Address - Phone:775-772-4012
Mailing Address - Fax:
Practice Address - Street 1:155 DAMONTE RANCH PKWY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-2990
Practice Address - Country:US
Practice Address - Phone:775-853-6416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV699156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician