Provider Demographics
NPI:1255905543
Name:ARNOLD, KAITLYN (OD)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6231 MOUNTIE WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-9412
Mailing Address - Country:US
Mailing Address - Phone:517-392-0970
Mailing Address - Fax:
Practice Address - Street 1:6231 MOUNTIE WAY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-9412
Practice Address - Country:US
Practice Address - Phone:517-392-0970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005511152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist