Provider Demographics
NPI:1578551206
Name:OLSON, BRENDA F (OD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:F
Last Name:OLSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 FALMOUTH HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-3660
Mailing Address - Country:US
Mailing Address - Phone:508-548-0505
Mailing Address - Fax:508-548-0382
Practice Address - Street 1:27 FALMOUTH HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-3660
Practice Address - Country:US
Practice Address - Phone:508-548-0505
Practice Address - Fax:508-548-0382
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3533152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0393797Medicaid
410024988OtherRAILROAD MEDICARE
MAW16042OtherBCBS
544140OtherUS HEALTHCARE
2200380OtherUNITED HEALTH CARE
759369OtherTUFTS
HARVARD PILGRIMOther151545
MA0538750001OtherDMERC
2200380OtherUNITED HEALTH CARE
544140OtherUS HEALTHCARE