Provider Demographics
NPI:1912094715
Name:OLSON, CARL (OD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:
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 1:855 MARLAND DR S
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-1923
Mailing Address - Country:US
Mailing Address - Phone:614-439-2275
Mailing Address - Fax:
Practice Address - Street 1:6116 BOARDWALK ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-2559
Practice Address - Country:US
Practice Address - Phone:614-430-8964
Practice Address - Fax:614-430-8965
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5137152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU85796Medicare UPIN
OHH180311Medicare PIN