Provider Demographics
NPI:1225148232
Name:ARNDT, KENNETH L (OD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:L
Last Name:ARNDT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:KENNETH
Other - Middle Name:LEE
Other - Last Name:ARNDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:
Practice Address - Street 1:422 ORIANA RD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-3733
Practice Address - Country:US
Practice Address - Phone:757-875-0675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000485152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0968540001OtherUS MEDICARE ADMINASTAR
VA009280910Medicaid
VA323483OtherANTHEM
VA323483OtherANTHEM
VA009280910Medicaid