Provider Demographics
NPI:1144533761
Name:OLSON, CHRISTOPHER ROBERT (OD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ROBERT
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 1:320 MCKENZIE AVE
Mailing Address - Street 2:STE 206
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-1002
Mailing Address - Country:US
Mailing Address - Phone:712-256-1111
Mailing Address - Fax:712-256-1549
Practice Address - Street 1:320 MCKENZIE AVE
Practice Address - Street 2:STE 206
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-1002
Practice Address - Country:US
Practice Address - Phone:712-256-1111
Practice Address - Fax:712-256-1549
Is Sole Proprietor?:No
Enumeration Date:2010-07-24
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002496152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist