Provider Demographics
NPI:1871553412
Name:ARNOLD, ROBERT J (OD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:ARNOLD
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:PO BOX 984
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-0984
Mailing Address - Country:US
Mailing Address - Phone:620-241-5810
Mailing Address - Fax:620-241-5810
Practice Address - Street 1:115 E MARLIN ST
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-4300
Practice Address - Country:US
Practice Address - Phone:620-241-5810
Practice Address - Fax:620-241-5810
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1015-2152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS3125270701Medicaid
KST43733Medicare UPIN
KS3125270701Medicaid
KS005270Medicare ID - Type Unspecified