Provider Demographics
NPI:1891145751
Name:OLSON, KURT ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:ROBERT
Last Name:OLSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66508-1841
Mailing Address - Country:US
Mailing Address - Phone:785-562-2631
Mailing Address - Fax:785-562-4006
Practice Address - Street 1:715 BROADWAY
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:KS
Practice Address - Zip Code:66508-1841
Practice Address - Country:US
Practice Address - Phone:785-562-2631
Practice Address - Fax:785-562-4006
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2034152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist