Provider Demographics
NPI:1700871373
Name:ARRIETA, JOSEPH CARLO (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CARLO
Last Name:ARRIETA
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 1:125 ROSEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2313
Mailing Address - Country:US
Mailing Address - Phone:830-249-8090
Mailing Address - Fax:830-249-8052
Practice Address - Street 1:125 ROSEWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2313
Practice Address - Country:US
Practice Address - Phone:830-249-8090
Practice Address - Fax:830-249-8052
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5533TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG000521E1Medicaid
TXU75082Medicare UPIN
TX00109XMedicare ID - Type Unspecified