Provider Demographics
NPI:1659717460
Name:ANTHONY J ARNOLD O D LLC
Entity Type:Organization
Organization Name:ANTHONY J ARNOLD O D LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-294-3243
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-20
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH4263152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0828484Medicaid
ARO694043Medicare PIN
OHU19154Medicare UPIN
OH0828484Medicaid