=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780917872
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VISION PLUS INSIDE SNOHOMISH TOP FOODS PS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2009
-----------------------------------------------------
Last Update Date | 11/23/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1301 AVENUE D
-----------------------------------------------------
City | SNOHOMISH
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98290-1711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-568-6868
-----------------------------------------------------
Fax | 360-568-6881
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1225 E SUNSET DR SUITE 125
-----------------------------------------------------
City | BELLINGHAM
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98226-3597
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-733-7393
-----------------------------------------------------
Fax | 360-733-5441
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MICHAEL JESSE SAUL
-----------------------------------------------------
Credential | O.D
-----------------------------------------------------
Telephone | 360-568-6868
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 602946857
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------