Provider Demographics
NPI:1841264249
Name:ARENCIBIA, JOSE MATIAS (OD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:MATIAS
Last Name:ARENCIBIA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:JOEY
Other - Middle Name:M
Other - Last Name:ARENCIBIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:344 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HIAWASSEE
Mailing Address - State:GA
Mailing Address - Zip Code:30546
Mailing Address - Country:US
Mailing Address - Phone:706-896-3303
Mailing Address - Fax:706-896-9485
Practice Address - Street 1:344 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HIAWASSEE
Practice Address - State:GA
Practice Address - Zip Code:30546
Practice Address - Country:US
Practice Address - Phone:706-896-3303
Practice Address - Fax:706-896-9485
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001176152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000442043CMedicaid
GA41ZCDPBMedicare ID - Type Unspecified
GA000442043CMedicaid