Provider Demographics
NPI:1285663260
Name:OLESHAK, JENNIFER OLGA
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:OLGA
Last Name:OLESHAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1687 HWY 395
Mailing Address - Street 2:UNIT 2
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423-0000
Mailing Address - Country:US
Mailing Address - Phone:775-783-8866
Mailing Address - Fax:775-783-1959
Practice Address - Street 1:1687 HWY 395
Practice Address - Street 2:UNIT 2
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-9999
Practice Address - Country:US
Practice Address - Phone:775-783-8866
Practice Address - Fax:775-783-1959
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV284156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV4032020001Medicare NSC