Provider Demographics
NPI:1669476610
Name:OLINECK, KATIE E (OD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:E
Last Name:OLINECK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:5200 DOUGLAS DR N
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3104
Mailing Address - Country:US
Mailing Address - Phone:763-537-3213
Mailing Address - Fax:763-537-6732
Practice Address - Street 1:13645 GROVE DR N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311
Practice Address - Country:US
Practice Address - Phone:763-420-8030
Practice Address - Fax:763-420-9842
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2876152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN644S6OLOtherBLUE CROSS/BLUE SHIELD
MNHP37235OtherHEALTH PARTNERS
MN22-01181OtherMEDICA PRIMARY
MN331J9OLOtherBLUE CROSS/BLUE SHIELD
MN171040OtherUCARE SRS AND MN
MN935301032789OtherPREFERRED ONE
MN964111032789OtherPREFERRED ONE
MN219596OtherCOLE MANAGED VISION
MN22-01908OtherMEDICA CHOICE
MN22-01907OtherSELECT CARE
MN22-01908OtherSELECT CARE
MN1808779OtherARAZ/AMERICA'S PPO
MN22-01907OtherMEDICA CHOICE
MN935301032789OtherPREFERRED ONE