Theodore Olenick, DO

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

8871750 Issued in ID

Practice address

90 Hope Dr BLDG 6000
Mountain Home Afb, ID 83648-1062

Phone

(208) 828-6806

NPI assigned

Mar 20, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Osteopathy

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

{
    "created_epoch": "1679270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784592000000",
    "number": "1396447025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 HOPE DR BLDG 6000",
            "city": "MOUNTAIN HOME AFB",
            "state": "ID",
            "postal_code": "836481062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 HOPE DR BLDG 6000",
            "city": "MOUNTAIN HOME AFB",
            "state": "ID",
            "postal_code": "836481062",
            "telephone_number": "208-828-6806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLENICK",
        "first_name": "THEODORE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-20",
        "last_updated": "2026-07-21",
        "certification_date": "2026-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "ID",
            "license": "8871750",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aaron Philip Morrison, PSYD
• Mt Home Refill Phcy
• Bichle Thi Nguyen, D.O.
• Paula Michelle Nordstrom, PH.D.
• McKenzie Leigh Nutter, DDS
• Roberto Olvera, LCSW
• Ariana Arely Oregel
• Leigh Anne Palmer
• Nathan Tuaefu Palmer, M.D.
• Cleo Patrick, PHD, LCSW, LICSW

• Pediatrics Physician in Mountain Home Afb, ID
• Providers in Mountain Home Afb, ID by specialty
• Pediatrics Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.