Provider Demographics
NPI:1790962348
Name:OLSEN VISION CARE, P.C.
Entity Type:Organization
Organization Name:OLSEN VISION CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-341-2062
Mailing Address - Street 1:501 E 15TH ST
Mailing Address - Street 2:STE 101
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5043
Mailing Address - Country:US
Mailing Address - Phone:405-341-2062
Mailing Address - Fax:405-341-6553
Practice Address - Street 1:501 E 15TH ST
Practice Address - Street 2:STE 101
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5043
Practice Address - Country:US
Practice Address - Phone:405-341-2062
Practice Address - Fax:405-341-6553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK881152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKT40595Medicare UPIN
OKOKB5365Medicare PIN
OK0648360001Medicare NSC