Provider Demographics
NPI:1801567292
Name:VISION PLUS OF MOUNT LAKE TERRACE PLLC
Entity type:Organization
Organization Name:VISION PLUS OF MOUNT LAKE TERRACE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
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 1:23009 56TH AVE W STE A
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-4713
Mailing Address - Country:US
Mailing Address - Phone:360-778-0133
Mailing Address - Fax:425-778-8833
Practice Address - Street 1:23009 56TH AVE W STE A
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-4713
Practice Address - Country:US
Practice Address - Phone:360-778-0113
Practice Address - Fax:425-778-8833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-24
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty