1811087786 NPI number — DR. PAULSEN COLEMAN ARNOLD O.D.

Table of content: DR. RAYMOND HUANG M.D. (NPI 1740428085)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811087786 NPI number — DR. PAULSEN COLEMAN ARNOLD O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARNOLD
Provider First Name:
PAULSEN
Provider Middle Name:
COLEMAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811087786
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2108 N PATTERSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALDOSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31602-2947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-244-3000
Provider Business Mailing Address Fax Number:
229-244-0399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
232 GREEN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27892-2000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-792-6611
Provider Business Practice Location Address Fax Number:
252-799-0797
Provider Enumeration Date:
10/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1696 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 890926F , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0926F . This is a "BCBSNC PIN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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