Healthcare Provider Details

I. General information

NPI: 1982956223
Provider Name (Legal Business Name): ARIGE NOHAD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4629 NW ACACIA DR
CORVALLIS OR
97330-3198
US

IV. Provider business mailing address

1505 NW HARRISON BLVD
CORVALLIS OR
97330-5816
US

V. Phone/Fax

Practice location:
  • Phone: 541-223-2326
  • Fax:
Mailing address:
  • Phone: 541-754-6222
  • Fax: 541-359-4281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3642ATI
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: