Provider Demographics
NPI:1336556091
Name:OLSON, KATHRYN ROSE (OD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ROSE
Last Name:OLSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ROSE
Other - Last Name:VAN DEN EINDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:340 FOX ST
Mailing Address - Street 2:
Mailing Address - City:PERHAM
Mailing Address - State:MN
Mailing Address - Zip Code:56573-1733
Mailing Address - Country:US
Mailing Address - Phone:218-346-3310
Mailing Address - Fax:218-346-9064
Practice Address - Street 1:340 FOX ST
Practice Address - Street 2:
Practice Address - City:PERHAM
Practice Address - State:MN
Practice Address - Zip Code:56573-1733
Practice Address - Country:US
Practice Address - Phone:218-346-3310
Practice Address - Fax:218-346-9064
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND720152W00000X
MN3402152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist