Provider Demographics
NPI:1861473290
Name:OLIVER, GERMAINE (OD)
Entity Type:Individual
Prefix:
First Name:GERMAINE
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:GERMAINE
Other - Middle Name:
Other - Last Name:KOLBLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 WOODHILL RD
Mailing Address - Street 2:
Mailing Address - City:MONSON
Mailing Address - State:MA
Mailing Address - Zip Code:01057-9743
Mailing Address - Country:US
Mailing Address - Phone:315-681-8227
Mailing Address - Fax:315-772-9498
Practice Address - Street 1:1448 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:MA
Practice Address - Zip Code:01069-1269
Practice Address - Country:US
Practice Address - Phone:413-283-2946
Practice Address - Fax:413-283-6361
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-11
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT626152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN