1730353897 NPI number — DR. LARRY L. OLSEN, O.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730353897 NPI number — DR. LARRY L. OLSEN, O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. LARRY L. OLSEN, O.D.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730353897
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 E 15TH ST
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
EDMOND
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73013-5043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-341-2062
Provider Business Mailing Address Fax Number:
405-341-6553

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 E 15TH ST
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
EDMOND
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73013-5043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-341-2062
Provider Business Practice Location Address Fax Number:
405-341-6553
Provider Enumeration Date:
04/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
OLSEN
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
405-341-2062

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , with the licence number:  881 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 881 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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