Provider Demographics
NPI:1851835896
Name:VISION PLUS IN MARYSVILLE, PS
Entity Type:Organization
Organization Name:VISION PLUS IN MARYSVILLE, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:AGINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-393-4000
Mailing Address - Street 1:2520 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-3545
Mailing Address - Country:US
Mailing Address - Phone:360-393-4000
Mailing Address - Fax:
Practice Address - Street 1:9516 STATE AVE STE A
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-2277
Practice Address - Country:US
Practice Address - Phone:360-658-5071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-09
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003639152W00000X
WAOD60555806152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8962807Medicare PIN
WA2049506Medicaid