Organization Active NPI

Olson Eye Care LLC

  • Optometrist
  • Waupun, WI
National Provider Identifier
1215119789
Registry record updated May 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
WI 2773 Issued in WI
Legal business name
OLSON EYE CARE LLC
Practice address
537 E Main St
Waupun, WI 53963-2162
Phone
(920) 324-3501
Fax
(920) 324-3380
NPI assigned
Nov 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Angie E Olson, ODNPI 1740254226
Title
Optometrist
Phone
(608) 833-0062

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X WI 2773 WI Primary

Addresses

Primary practice location

537 E Main St
Waupun, WI 53963-2162

Mailing address

537 E Main St
PO Box 350
Waupun, WI 53963-2162
Phone (920) 324-3501

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080208000591 WI Part B Supplier - Clinic/Group Practice 5294818589 Receives reassigned benefits from 6 practitioners
Practice locations: Lake Mills, WI; Madison, WI; Waupun, WI

National Provider Directory

National Provider Directory

Locations

395 W Tyranena Park Rd
Lake Mills, WI 53551

395 W Tyranena Park Rd
#5
Lake Mills, WI 53551
Phone (920) 648-2011

462 Commerce Dr
Ste A
Madison, WI 53719
Phone (608) 833-0062

503 Commerce Dr
Madison, WI 53719
Phone (608) 833-0062

537 E Main St
Waupun, WI 53963
Phone (920) 324-3501

102 Shaler Dr
Waupun, WI 53963
Phone (920) 324-3501

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275004800000",
    "number": "1215119789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "537 E MAIN ST",
            "address_2": "PO BOX 350",
            "city": "WAUPUN",
            "state": "WI",
            "postal_code": "539632162",
            "telephone_number": "920-324-3501",
            "fax_number": "920-324-3380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "537 E MAIN ST",
            "city": "WAUPUN",
            "state": "WI",
            "postal_code": "539632162",
            "telephone_number": "920-324-3501",
            "fax_number": "920-324-3380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLSON EYE CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-27",
        "last_updated": "2010-05-28",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "608-833-0062",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WI",
            "license": "WI 2773",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waupun, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.