Provider Demographics
NPI:1598469835
Name:ARANDIA, MARCO ALBERTO (OD STUDENT)
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:ALBERTO
Last Name:ARANDIA
Suffix:
Gender:M
Credentials:OD STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22009
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97269-2009
Mailing Address - Country:US
Mailing Address - Phone:503-558-7372
Mailing Address - Fax:503-344-5140
Practice Address - Street 1:9555 SW BARNES RD STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6668
Practice Address - Country:US
Practice Address - Phone:503-227-2020
Practice Address - Fax:503-296-9934
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORATI4741152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist