Provider Demographics
NPI:1821404955
Name:ARNOLD, BRETT (OD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:
Last Name:ARNOLD
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 1:1565 EASTOVER PLACE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104
Mailing Address - Country:US
Mailing Address - Phone:734-759-2909
Mailing Address - Fax:734-929-4142
Practice Address - Street 1:1565 EASTOVER PLACE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104
Practice Address - Country:US
Practice Address - Phone:734-759-2909
Practice Address - Fax:734-929-4142
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004851152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4901004851OtherMICHIGAN OPTOMETRY LICENSE