Individual
BRIAN ARTHUR ARVIDSON I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D
Contact information
Practice address
2517 NE KRESKY AVE, CHEHALIS, WA 98532-2409
(360) 748-8632
(360) 748-3869
Mailing address
PO BOX 1506, CHEHALIS, WA 98532-0409
(360) 242-3008
(360) 807-7687
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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