Provider Demographics
NPI:1659332583
Name:ARZUAGA, MADALEN (OD)
Entity Type:Individual
Prefix:DR
First Name:MADALEN
Middle Name:
Last Name:ARZUAGA
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 1:2045 MARKET PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7931
Mailing Address - Country:US
Mailing Address - Phone:678-208-1250
Mailing Address - Fax:678-208-1255
Practice Address - Street 1:2045 MARKET PLACE BLVD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7931
Practice Address - Country:US
Practice Address - Phone:678-208-1250
Practice Address - Fax:678-208-1255
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT0068551152W00000X
GAOPT002371152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA4517Medicare ID - Type Unspecified
V01533Medicare UPIN