Provider Demographics
NPI:1659312056
Name:BAINBRIDGE VISION INC PS
Entity Type:Organization
Organization Name:BAINBRIDGE VISION INC PS
Other - Org Name:BAINBRIDGE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:EGASHIRA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:206-842-6604
Mailing Address - Street 1:345 KNECHTEL WAY NE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2860
Mailing Address - Country:US
Mailing Address - Phone:206-842-6604
Mailing Address - Fax:206-842-6605
Practice Address - Street 1:345 KNECHTEL WAY NE
Practice Address - Street 2:SUITE 104
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2860
Practice Address - Country:US
Practice Address - Phone:206-842-6604
Practice Address - Fax:206-842-6605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2067152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA20233273Medicaid
WA20233273Medicaid
WA0521000002Medicare PIN
WACJ6631Medicare PIN