Pacific Eyecare of Poulsbo PS

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

MD00029555 Issued in WA

Legal business name

PACIFIC EYECARE OF POULSBO PS

Doing business as

Pacific Optical

Practice address

1100 Madison Ave N
Bainbridge Island, WA 98110-1781

Phone

(206) 842-2020

Fax

(206) 780-2020

NPI assigned

Oct 24, 2005

Last updated

Jun 19, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

David JC Omorehue

Title

MD/Owner

Phone

(360) 779-2020

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Pacific Optical Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213833600000",
    "number": "1083604946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20669 BOND RD NE",
            "address_2": "STE 100",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983706525",
            "telephone_number": "360-779-2020",
            "fax_number": "360-779-3093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 MADISON AVE N",
            "city": "BAINBRIDGE ISLAND",
            "state": "WA",
            "postal_code": "981101781",
            "telephone_number": "206-842-2020",
            "fax_number": "206-780-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC EYECARE OF POULSBO PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-24",
        "last_updated": "2008-06-19",
        "status": "A",
        "authorized_official_last_name": "OMOREHUE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "JC",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "360-779-2020"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "WA",
            "license": "MD00029555",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2025633",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific Optical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Eyewear Supplier in Bainbridge Island, WA
• Providers in Bainbridge Island, WA by specialty
• Eyewear Supplier in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.