Provider Demographics
NPI:1861494114
Name:ARNOLD, PRISCILLA PERRY (MD)
Entity Type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:PERRY
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PRISCILLA
Other - Middle Name:ETHEL
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:777 TANGLEFOOT LN
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1650
Mailing Address - Country:US
Mailing Address - Phone:563-323-2020
Mailing Address - Fax:563-328-5694
Practice Address - Street 1:2001 5TH ST
Practice Address - Street 2:SUITE 49
Practice Address - City:SILVIS
Practice Address - State:IL
Practice Address - Zip Code:61282-2903
Practice Address - Country:US
Practice Address - Phone:309-792-2020
Practice Address - Fax:309-792-4753
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036124585207W00000X
IA38713207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00450781OtherPALMETTO GBA - RAILROAD MEDICARE
IL036124585Medicaid
IA1861494114Medicaid
P00450781OtherPALMETTO GBA - RAILROAD MEDICARE
B61107Medicare UPIN
IA1861494114Medicaid
MO0352090001Medicare NSC