Brian Arthur Arvidson I, O.D
Individual provider Active NPI Optometrist · Chehalis, WA
NPI 1508050337 · NPPES record last updated Nov 13, 2020
Key facts
- NPI
- 1508050337
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- OD60119604 (WA)
- Practice address
- 2517 NE Kresky Ave
Chehalis, WA 98532-2409 - Phone
- (360) 748-8632
- Fax
- (360) 748-3869
- NPI assigned
- Sep 5, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 17
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Pacific University - College of Optometry, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Pacific Cataract and Laser Institute Inc PC
Practice addresses (Care Compare)
19801 SW 72ND Ave
Suite 150
Tualatin, OR 97062-8347
Phone (503) 691-2283
2517 NE Kresky Ave
Chehalis, WA 98532-2433
Phone (360) 748-8632
2915 S Alder St
Tacoma, WA 98409-4803
Phone (253) 473-0275
3330 4TH St
Lewiston, ID 83501-4405
Phone (208) 746-2025
6695 W Rio Grande Ave
Kennewick, WA 99336-3301
Phone (509) 736-0826
9309 NE 86TH St
Vancouver, WA 98662-2100
Phone (360) 694-2544
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in OR, WA, ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20071011000711 | OR | Practitioner - Optometry | 0143316737 | Reassigns benefits to 1 organization |
| I20110623000066 | WA | Practitioner - Optometry | 0143316737 | Reassigns benefits to 1 organization |
| I20111006000228 | ID | Practitioner - Optometry | 0143316737 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ODP-100229 | ID | MD | Optometrist |
| 3220 ATI | OR | MD | Optometrist |
| ATI3220 | OR | MD | Optometrist |
| OD60119604 | WA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pacific Cataract and Laser Institute Inc PC | Current | Accepting new patients | |
| Pacific Cataract and Laser Institute Inc PC | Current | Accepting new patients | |
| Pacific Cataract and Laser Institute, Inc., P.C. | Current |
Accepting new patients | |
| Pacific Cataract and Laser Institute Inc PC | Current | Accepting new patients | |
| Pacific Cataract and Laser Institute Inc PC | Current | Accepting new patients | |
| Pacific Cataract and Laser Institute, Inc., P.C. | Current |
Accepting new patients | |
| Pacific Cataract and Laser Institute, Inc., P.C. | Current | Accepting new patients | |
| Pacific Cataract and Laser Institute, Inc., P.C. | Current |
Accepting new patients | |
| NPI 1245471788 | Current |
Accepting new patients | |
| Pacific University | Past | Accepting new patients |
Locations
2822 S Vista Ave
Boise, ID 83705
Phone (208) 385-7576
3330 4th St
Lewiston, ID 83501
Phone (208) 746-2025
1331 NW Lovejoy St
Ste 750
Portland, OR 97209
Phone (503) 535-2883
19801 SW 72nd Ave
Ste 150
Tualatin, OR 97062
Phone (503) 691-2283
2606 116th Ave NE
Ste 100
Bellevue, WA 98004
Phone (425) 462-7664
4330 Mitchell Way
Bellingham, WA 98226
Phone (360) 736-6860
2517 NE Kresky Ave
Chehalis, WA 98532
Phone (360) 748-8632
6695 W Rio Grande Ave
Kennewick, WA 99336
Phone (509) 736-0826
115 New View Ct NE
Olympia, WA 98506
Phone (360) 252-1642
9598 Mickelberry Rd NW
Silverdale, WA 98383
Phone (360) 698-5062
16818 E Desmet Ct
Spokane Valley, WA 99216
Phone (360) 242-3008
2915 S Alder St
Tacoma, WA 98409
Phone (253) 473-0275
2205 NE 129th St
Vancouver, WA 98686
Phone (360) 450-6644
3900 Kern Rd
Yakima, WA 98902
Phone (509) 966-1356
Interoperability endpoints
- brian.arvidson.p1@direct.pcli.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | ATI3220 | OR | |
| Optometrist | 152W00000X | ODP-100229 | ID | |
| Optometrist | 152W00000X | 3220 ATI | OR | |
| Optometrist | 152W00000X | OD60119604 | WA | Yes |
Addresses
Primary practice location
2517 NE Kresky Ave
Chehalis, WA 98532-2409
Mailing address
PO Box 1506
Chehalis, WA 98532-0409
Phone (360) 242-3008
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| R159615 | Other | OR | MEDICARE OR |
| 00773081 | Other | OR | MEDICARE RAILROAD |
| 2012795 | Medicaid | WA | |
| 274666 | Medicaid | OR | |
| G8900939 | Other | WA | MEDICARE WA |
| 1594538 | Other | ID | MEDICARE ID |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | brian.arvdison.p1@direct.pcli.nextgenshare.com |
Other providers in Chehalis, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 13, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.