Individual
BRIAN ARTHUR ARVIDSON I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
3220 ATI
OR
152W00000X
Optometrist
ATI3220
OR
152W00000X
Optometrist
Primary
OD60119604
WA
152W00000X
Optometrist
ODP-100229
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00773081
MEDICARE RAILROAD
OR
01
—
1594538
MEDICARE ID
ID
05
—
2012795
—
WA
05
—
274666
—
OR
01
—
G8900939
MEDICARE WA
WA
01
—
R159615
MEDICARE OR
OR
Enumeration date
09/05/2007
Last updated
11/13/2020
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