Provider Demographics
NPI:1780917872
Name:VISION PLUS INSIDE SNOHOMISH TOP FOODS PS
Entity type:Organization
Organization Name:VISION PLUS INSIDE SNOHOMISH TOP FOODS PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JESSE
Authorized Official - Last Name:SAUL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-568-6868
Mailing Address - Street 1:1225 E SUNSET DR
Mailing Address - Street 2:SUITE 125
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-3597
Mailing Address - Country:US
Mailing Address - Phone:360-733-7393
Mailing Address - Fax:360-733-5441
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:360-568-6881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602946857152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2006242Medicaid
WA6383380001Medicare NSC
WAG8887764Medicare PIN