Provider Demographics
NPI:1700857687
Name:KRADEN, ARNOLD (OD)
Entity Type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:
Last Name:KRADEN
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 1:20/20 WESTSIDE EYECARE
Mailing Address - Street 2:324 WEST FERRY ST.
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-1957
Mailing Address - Country:US
Mailing Address - Phone:716-883-4747
Mailing Address - Fax:716-883-4764
Practice Address - Street 1:20/20 WESTSIDE EYECARE
Practice Address - Street 2:324 WEST FERRY ST.
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-1957
Practice Address - Country:US
Practice Address - Phone:716-883-4747
Practice Address - Fax:716-883-4764
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYV003048-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00631365Medicaid
NY061391Medicare PIN
NY0160280002Medicare NSC
NY061397Medicare PIN
NY00631365Medicaid