Provider Demographics
NPI:1497732663
Name:ARNDT, PERRY A (OD)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:A
Last Name:ARNDT
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 1:309 E BROADWAY AVE
Mailing Address - Street 2:P.O. BOX 547
Mailing Address - City:MEDFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54451-1835
Mailing Address - Country:US
Mailing Address - Phone:715-748-2020
Mailing Address - Fax:715-748-4565
Practice Address - Street 1:309 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451-1835
Practice Address - Country:US
Practice Address - Phone:715-748-2020
Practice Address - Fax:715-748-4565
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1421152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38715100Medicaid
WI39-1229699OtherFEDERAL TAX ID - MEDFORD
WI391967186019OtherBLUE CROSS BLUE SHIELD-CO
WI410031756OtherRAILROAD MEDICARE-MEDFORD
WI1271670001OtherDMERC-COLBY GROUP
WI391229699015OtherBLUE CROSS BLUE SHIELD-ME
WI410045064OtherRAILROAD MEDICARE-COLBY
WI9103OtherSECURITY HEALTH PLAN-COLB
WI0474980001OtherDMERC-MEDFORD GROUP
WI3862100Medicaid
WI38715300Medicaid
WI1421OtherLISCENSE NUMBER
WI10445OtherNVA-MEDFORD
WI750OtherSECURITY HEALTH PLAN-MEDF
WI39-1967186OtherFEDERAL TAX ID - COLBY
WI39-1967186OtherFEDERAL TAX ID - COLBY