Provider Demographics
NPI:1811089188
Name:ARNISTA, THOMAS MATTHEW (OD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:MATTHEW
Last Name:ARNISTA
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 1:220 WELCH RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-1013
Mailing Address - Country:US
Mailing Address - Phone:860-620-9681
Mailing Address - Fax:
Practice Address - Street 1:220 WELCH RD
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-1013
Practice Address - Country:US
Practice Address - Phone:203-333-4828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2025152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
048378OtherCONNECTICARE
090002025CT03OtherBC/BS
CT004091899Medicaid
OV6117OtherHEALTHNET
910556OtherBLOCK/CHN
CT004091899Medicaid
T87273Medicare UPIN