Provider Demographics
NPI:1083722755
Name:ARNOLD, ANTHONY J (OD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 HOUPT DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:UPPER SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:43351-8904
Mailing Address - Country:US
Mailing Address - Phone:419-294-3243
Mailing Address - Fax:419-294-1372
Practice Address - Street 1:97 HOUPT DR
Practice Address - Street 2:SUITE C
Practice Address - City:UPPER SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:43351-8904
Practice Address - Country:US
Practice Address - Phone:419-294-3243
Practice Address - Fax:419-294-1372
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4263 T22152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0828484Medicaid
OH0448110001Medicare NSC
OH0828484Medicaid
ARO694043Medicare ID - Type Unspecified