Provider Demographics
NPI:1497873129
Name:BRUCE A. OLSON D.P.M., INC.
Entity Type:Organization
Organization Name:BRUCE A. OLSON D.P.M., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:ALTON
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:805-486-8710
Mailing Address - Street 1:2035 SAVIERS RD
Mailing Address - Street 2:SUITE 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:SUITE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA213E00000X
CAE1206332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E12060Medicaid
CAT19078Medicare UPIN
CAWE5915Medicare ID - Type Unspecified
0883610001Medicare NSC