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General NPI Number Information
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NPI Number | 1154536217
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Entity Type | Organization
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Legal Business Name | DIVISION EYECARE
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 01/22/2014
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Provider Practice Location Address
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Address Line | 31775 STATE ROUTE 20 SUITE B
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City | OAK HARBOR
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State | WA
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Zip | 98277-5139
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Country | US
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Telephone | 360-544-5843
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Fax | 360-544-5839
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Provider Business Mailing Address
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Address Line | 31775 STATE ROUTE 20 SUITE B
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City | OAK HARBOR
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State | WA
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Zip | 98277-5139
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Country | US
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Telephone | 360-544-5843
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Fax | 360-544-5839
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK D AGINSKY
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Credential | OD
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Telephone | 360-544-5843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD00003639
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License Number State | WA
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