Individual provider Active NPI

Robert Lee Olsen, MD

  • Ophthalmology Physician
  • Rochester, NY
National Provider Identifier
1508826579
Registry record updated Oct 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
150483 Issued in NY
Practice address
2301 Lac de Ville Blvd
Rochester, NY 14618-5646
Phone
(585) 244-0332
Fax
(585) 473-8833
NPI assigned
Mar 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 150483 NY Primary

Addresses

Primary practice location

2301 Lac de Ville Blvd
Rochester, NY 14618-5646

Mailing address

2301 Lac de Ville Blvd
Rochester, NY 14618-5646
Phone (585) 244-0332

Other identifiers 1

IdentifierTypeStateIssuer
009003140MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060207000702 NY Practitioner - Ophthalmology 9739084211 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
150483NYMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rochester General Hospital Current Accepting new patients
Rochester General Hospital CurrentSince Oct 1, 2004 Accepting new patients
Rochester Eye Associates Physicians and Surgeons PC CurrentSince Jan 1, 1998 Accepting new patients
Rochester General Hospital CurrentSince Oct 1, 2004 Accepting new patients

Locations

1425 Portland Ave
Rochester, NY 14621
Phone (585) 922-3122

2301 Lac de Ville Blvd
Rochester, NY 14618
Phone (585) 244-0332

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414454400000",
    "number": "1508826579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 LAC DE VILLE BLVD",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146185646",
            "telephone_number": "585-244-0332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 LAC DE VILLE BLVD",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146185646",
            "telephone_number": "585-244-0332",
            "fax_number": "585-473-8833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSEN",
        "first_name": "ROBERT",
        "middle_name": "LEE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-24",
        "last_updated": "2014-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NY",
            "license": "150483",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009003140",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

Verify at the official NPI Registry.