Provider Demographics
NPI:1508826579
Name:OLSEN, ROBERT LEE (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEE
Last Name:OLSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 LAC DE VILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5646
Mailing Address - Country:US
Mailing Address - Phone:585-244-0332
Mailing Address - Fax:
Practice Address - Street 1:2301 LAC DE VILLE BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5646
Practice Address - Country:US
Practice Address - Phone:585-244-0332
Practice Address - Fax:585-473-8833
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150483207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC009003140Medicaid
NC009003140Medicaid
NYD01773Medicare UPIN