Provider Demographics
NPI:1679550396
Name:OLSON, NICHOLE AMINA (OD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLE
Middle Name:AMINA
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:PSC 477 BOX 2
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:FP
Mailing Address - Zip Code:96306
Mailing Address - Country:US
Mailing Address - Phone:0118146-763-4783
Mailing Address - Fax:
Practice Address - Street 1:USNH YOKOSUKA JAPAN
Practice Address - Street 2:PSC 475 BOX 1
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96350
Practice Address - Country:US
Practice Address - Phone:0118146-763-4783
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001294152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist