Provider Demographics
NPI:1619205242
Name:JANE OLSON MD
Entity Type:Organization
Organization Name:JANE OLSON MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCULOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-766-0005
Mailing Address - Street 1:8440 BLUEBONNET BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-2978
Mailing Address - Country:US
Mailing Address - Phone:225-766-0005
Mailing Address - Fax:225-766-0131
Practice Address - Street 1:8440 BLUEBONNET BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2978
Practice Address - Country:US
Practice Address - Phone:225-766-0005
Practice Address - Fax:225-766-0131
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JANE OLSON MD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD201863261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center