Provider Demographics
NPI:1578596656
Name:O, EINAR OLLANDER (CP)
Entity Type:Individual
Prefix:MR
First Name:EINAR
Middle Name:OLLANDER
Last Name:O
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 N FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-2113
Mailing Address - Country:US
Mailing Address - Phone:727-726-6178
Mailing Address - Fax:727-937-2831
Practice Address - Street 1:1006 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-2113
Practice Address - Country:US
Practice Address - Phone:727-726-6178
Practice Address - Fax:727-937-2831
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPRO64174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0324850001Medicare NSC