Provider Demographics
NPI:1902076466
Name:MARCIE ARNESTY-OLIAN, OD, A PROF CORP
Entity Type:Organization
Organization Name:MARCIE ARNESTY-OLIAN, OD, A PROF CORP
Other - Org Name:BOREL EYE DOCTORS OPTOMETRY WITH VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / OPTOMETRIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ARNESTY-OLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:650-570-5955
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7122T152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1246610001Medicare NSC