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WASHINGTON RETINA, PLLC

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Company Details

Legal Name: WASHINGTON RETINA, PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Active
Formation/ Registration Date: April 5th 2022
Expiration date: 30 Apr 2026
UBI Number: 604 896 151
ZIP code: 98002
City: Auburn
County: KING
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 125 3RD ST NE, STE 200, AUBURN, WA, 98002, UNITED STATES

Contact Details

E-Mail: SERVICECO@MPBA.COM

Nature of Business

Other Services, SPECIALTY OPHTHALMOLOGIC CARE

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Registered Agent Information

Name Role Address
MPBA SERVICE COMPANY LLC Registered Agent 701 5TH AVE STE 5500, SEATTLE, WA, 98104-7096, UNITED STATES

Key Officers & Management

Name Role Address
RAHUL MANDIGA Executor 105 MALL WAY, #1021, MARYSVILLE, WA, 98270, UNITED STATES
BENJAMIN REISS Executor 105 MALL WAY, #1021, MARYSVILLE, WA, 98270, UNITED STATES
RAHUL MANDIGA Governing Person -
BENJAMIN REISS Governing Person -

National Provider Identifier

NPI Number:
1215672084
Certification Date:
2023-04-03

Authorized Person:

Name:
DR. RAHUL MANDIGA
Role:
MEMBER
Phone:

Taxonomy:

Selected Taxonomy:
207W00000X - Ophthalmology Physician
Is Primary:
No
Selected Taxonomy:
207WX0107X - Retina Specialist (Ophthalmology) Physician
Is Primary:
Yes

Contacts:

Fax:
2532759000
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