Provider Demographics
NPI:1427103787
Name:ARNESTY, MARCIE ELLEN (OD)
Entity type:Individual
Prefix:DR
First Name:MARCIE
Middle Name:ELLEN
Last Name:ARNESTY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MARCIE
Other - Middle Name:ELLEN
Other - Last Name:ARNESTY-OLIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:37 BOVET RD
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3104
Mailing Address - Country:US
Mailing Address - Phone:650-570-5955
Mailing Address - Fax:650-570-7124
Practice Address - Street 1:37 BOVET RD
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3104
Practice Address - Country:US
Practice Address - Phone:650-570-5955
Practice Address - Fax:650-570-7124
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7122T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0071220Medicare UPIN
CA1246610001Medicare NSC