Provider Demographics
NPI:1821597519
Name:OLSEN, JAREN (OD)
Entity type:Individual
Prefix:
First Name:JAREN
Middle Name:
Last Name:OLSEN
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 1:3508 S 25TH E
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-5027
Mailing Address - Country:US
Mailing Address - Phone:208-557-3222
Mailing Address - Fax:208-561-8692
Practice Address - Street 1:3508 S 25TH E
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-5027
Practice Address - Country:US
Practice Address - Phone:208-557-3222
Practice Address - Fax:208-561-8692
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-100631152WL0500X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation