Provider Demographics
NPI:1265577183
Name:OLSON, GREGORY ALLEN (OD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALLEN
Last Name:OLSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:13105 OLD HANOVER ROAD
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136
Mailing Address - Country:US
Mailing Address - Phone:410-526-2724
Mailing Address - Fax:
Practice Address - Street 1:400 N CENTER ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5140
Practice Address - Country:US
Practice Address - Phone:410-857-4200
Practice Address - Fax:410-848-9295
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0993152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD579820OtherHIGHMARK BLUE CROSS
MD08568OtherSPECTERA
MD2143327OtherMAMSI
MD2124OtherBALTIMORE CITY VISION
MD210412OtherNATIONAL VISION ADMIN
MD16626OtherAVESIS
MD44452OtherDAVIS VISION