Provider Demographics
NPI:1881666162
Name:OLSON, JON OLOF (OD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:OLOF
Last Name:OLSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8100 34 AVE S
Mailing Address - Street 2:MC21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1672
Mailing Address - Country:US
Mailing Address - Phone:952-883-7172
Mailing Address - Fax:952-883-5395
Practice Address - Street 1:1210 COUNTY ROAD E W
Practice Address - Street 2:
Practice Address - City:ARDEN HILLS
Practice Address - State:MN
Practice Address - Zip Code:55112-3783
Practice Address - Country:US
Practice Address - Phone:651-523-8400
Practice Address - Fax:651-484-9650
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2022-03-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN2055152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN388323000Medicaid