Provider Demographics
NPI:1780725242
Name:ARNDT, WESLEY WAYNE (OD)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:WAYNE
Last Name:ARNDT
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 1:12530 ADMIRALTY WAY
Mailing Address - Street 2:B-102
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-5597
Mailing Address - Country:US
Mailing Address - Phone:425-438-1546
Mailing Address - Fax:
Practice Address - Street 1:8530 EVERGREEN WAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-2614
Practice Address - Country:US
Practice Address - Phone:425-353-2750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA026101 OD00001028152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2026508Medicaid
WA0100186Medicare ID - Type Unspecified