Provider Demographics
NPI:1508050337
Name:ARVIDSON, BRIAN ARTHUR I (OD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:ARTHUR
Last Name:ARVIDSON
Suffix:I
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:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0409
Mailing Address - Country:US
Mailing Address - Phone:360-242-3008
Mailing Address - Fax:360-807-7687
Practice Address - Street 1:2517 NE KRESKY AVE
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-2409
Practice Address - Country:US
Practice Address - Phone:360-748-8632
Practice Address - Fax:360-748-3869
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORATI3220152W00000X
IDODP-100229152W00000X
OR3220 ATI152W00000X
WAOD60119604152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR159615OtherMEDICARE OR
OR00773081OtherMEDICARE RAILROAD
WA2012795Medicaid
OR274666Medicaid
WAG8900939OtherMEDICARE WA
ID1594538OtherMEDICARE ID