Provider Demographics
NPI:1730169285
Name:AGINSKY, MARK DORON (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:DORON
Last Name:AGINSKY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 JAMES STREET
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-3830
Mailing Address - Country:US
Mailing Address - Phone:360-733-7393
Mailing Address - Fax:360-733-5441
Practice Address - Street 1:2520 JAMES STREET
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:360-733-5441
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3639152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2033199Medicaid
5310510001Medicare NSC
WAU89288Medicare UPIN
WA2033199Medicaid
WA6924350001Medicare NSC