Provider Demographics
NPI:1700927480
Name:ASHBAKER VISION CLINIC INC
Entity Type:Organization
Organization Name:ASHBAKER VISION CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:ASHBAKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-695-3829
Mailing Address - Street 1:8217 E MILL PLAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-2004
Mailing Address - Country:US
Mailing Address - Phone:360-695-3829
Mailing Address - Fax:360-695-7718
Practice Address - Street 1:8217 E MILL PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-2004
Practice Address - Country:US
Practice Address - Phone:360-695-3829
Practice Address - Fax:360-695-7718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD3779152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU93847Medicare UPIN
WAAB34971Medicare PIN