Provider Demographics
NPI:1083827372
Name:EYECO OPTOMETRY PS
Entity type:Organization
Organization Name:EYECO OPTOMETRY PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:AGINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-733-7393
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:360-722-7785
Practice Address - Street 1:2520 JAMES ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-3830
Practice Address - Country:US
Practice Address - Phone:360-733-7393
Practice Address - Fax:360-722-7785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3639152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2026342Medicaid
8858266Medicare ID - Type Unspecified
WADS7823Medicare PIN
WA5310510001Medicare NSC
WAG8904947Medicare PIN