Provider Demographics
NPI:1346558053
Name:OLYMPUS SOLUTIONS, INC.
Entity Type:Organization
Organization Name:OLYMPUS SOLUTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:TEREZAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-676-8845
Mailing Address - Street 1:1134 S CLEARVIEW PKWY
Mailing Address - Street 2:SUITE D-133
Mailing Address - City:HARAHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70123-2399
Mailing Address - Country:US
Mailing Address - Phone:504-676-8845
Mailing Address - Fax:504-335-0740
Practice Address - Street 1:1134 S CLEARVIEW PKWY
Practice Address - Street 2:SUITE D-133
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-2399
Practice Address - Country:US
Practice Address - Phone:504-676-8845
Practice Address - Fax:504-335-0740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA010404207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA010404OtherLICENCE