Provider Demographics
NPI:1922182104
Name:SAUL, MICHAEL J (OD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:SAUL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:J
Other - Last Name:SAUL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:20231 209TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-9371
Mailing Address - Country:US
Mailing Address - Phone:360-805-2594
Mailing Address - Fax:
Practice Address - Street 1:1301 AVENUE D
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-1711
Practice Address - Country:US
Practice Address - Phone:360-568-6868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1570TX152W00000X
WA1507TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB36653Medicare ID - Type Unspecified
WAG887765Medicare PIN
WA6383380001Medicare NSC