Healthcare Provider Details

I. General information

NPI: 1073711222
Provider Name (Legal Business Name): KOLLAN PARKER ARRITT O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 W ELM AVE
HERMISTON OR
97838-6933
US

IV. Provider business mailing address

6900 ALDEN DR
FT WARREN AFB WY
82005-3906
US

V. Phone/Fax

Practice location:
  • Phone: 541-567-6623
  • Fax:
Mailing address:
  • Phone: 307-481-2565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberATI-3349
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: