Provider Demographics
NPI:1912216094
Name:OLSON, JACINTA (OD, MED/VFL)
Entity Type:Individual
Prefix:DR
First Name:JACINTA
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:OD, MED/VFL
Other - Prefix:DR
Other - First Name:JACINTA
Other - Middle Name:
Other - Last Name:YEUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD, MED/VFL
Mailing Address - Street 1:1692 30TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1034
Mailing Address - Country:US
Mailing Address - Phone:303-449-0857
Mailing Address - Fax:303-444-6560
Practice Address - Street 1:1692 30TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1034
Practice Address - Country:US
Practice Address - Phone:034-490-8573
Practice Address - Fax:303-444-6560
Is Sole Proprietor?:No
Enumeration Date:2010-10-06
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0002998152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy