Provider Demographics
NPI:1356679807
Name:OLSON EYE CARE LLC
Entity Type:Organization
Organization Name:OLSON EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-324-3501
Mailing Address - Street 1:537 E MAIN ST
Mailing Address - Street 2:PO BOX 350
Mailing Address - City:WAUPUN
Mailing Address - State:WI
Mailing Address - Zip Code:53963-2162
Mailing Address - Country:US
Mailing Address - Phone:920-324-3501
Mailing Address - Fax:920-324-3380
Practice Address - Street 1:537 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WAUPUN
Practice Address - State:WI
Practice Address - Zip Code:53963-2162
Practice Address - Country:US
Practice Address - Phone:920-324-3501
Practice Address - Fax:920-324-3380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2773152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38611800Medicaid
WI000087185OtherMEDICARE PROVIDER