Provider Demographics
NPI:1548364540
Name:VON ARB, BRIAN RONALD (OD)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:RONALD
Last Name:VON ARB
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5792 JAMEBARD ROAD
Mailing Address - Street 2:
Mailing Address - City:HERMANTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55811-3941
Mailing Address - Country:US
Mailing Address - Phone:218-729-9025
Mailing Address - Fax:
Practice Address - Street 1:4740 W MALL DRIVE
Practice Address - Street 2:
Practice Address - City:HERMANTOWN
Practice Address - State:MN
Practice Address - Zip Code:55811-3941
Practice Address - Country:US
Practice Address - Phone:218-727-1204
Practice Address - Fax:218-727-0933
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2222152W00000X
WI2266152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2K923V0Medicare ID - Type Unspecified
T66260Medicare UPIN