Provider Demographics
NPI:1801045729
Name:OLSON, KRISTEN N (OD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:N
Last Name:OLSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:SCHUCHARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1818 52ND ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-7748
Mailing Address - Country:US
Mailing Address - Phone:701-426-7390
Mailing Address - Fax:
Practice Address - Street 1:4731 13TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-7269
Practice Address - Country:US
Practice Address - Phone:701-281-2746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3158152W00000X
ND674152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist