Provider Demographics
NPI:1417361569
Name:ARNETT, PAMELA DAWN (OD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:DAWN
Last Name:ARNETT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4207 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-2910
Mailing Address - Country:US
Mailing Address - Phone:718-204-6667
Mailing Address - Fax:718-427-9903
Practice Address - Street 1:4207 30TH AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-2910
Practice Address - Country:US
Practice Address - Phone:718-204-6667
Practice Address - Fax:718-427-9903
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008189152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist