Provider Demographics
NPI:1174551709
Name:OLSON, JOHN C (MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:C
Last Name:OLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3824 OAKWATER CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6263
Mailing Address - Country:US
Mailing Address - Phone:407-425-7188
Mailing Address - Fax:407-423-9040
Practice Address - Street 1:3824 OAKWATER CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-6263
Practice Address - Country:US
Practice Address - Phone:407-425-7188
Practice Address - Fax:407-423-9040
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME38233207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL180027280OtherRR MEDICARE
FL066746300Medicaid
FL47496ZMedicare PIN
FLD62331Medicare UPIN