Healthcare Provider Details

I. General information

NPI: 1598469835
Provider Name (Legal Business Name): MARCO ALBERTO ARANDIA OD STUDENT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9555 SW BARNES RD STE 100
PORTLAND OR
97225-6668
US

IV. Provider business mailing address

PO BOX 22009
PORTLAND OR
97269-2009
US

V. Phone/Fax

Practice location:
  • Phone: 503-227-2020
  • Fax: 503-296-9934
Mailing address:
  • Phone: 503-558-7372
  • Fax: 503-344-5140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberATI4741
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: