Provider Demographics
NPI:1710074430
Name:MCIRVIN, ARTHUR H (OD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:H
Last Name:MCIRVIN
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 1:1025 S 320TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5358
Mailing Address - Country:US
Mailing Address - Phone:253-839-1028
Mailing Address - Fax:253-839-1029
Practice Address - Street 1:1025 S 320TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5358
Practice Address - Country:US
Practice Address - Phone:253-839-1028
Practice Address - Fax:253-839-1029
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1168152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2040905Medicaid
WA2040905Medicaid
T01725Medicare UPIN