Pasco Vision Clinic P S

Primary specialty

OptometristTaxonomy code 152W00000X

License

38 Issued in WA

Legal business name

PASCO VISION CLINIC P S

Practice address

2715 W Court St
Pasco, WA 99301-3911

Phone

(509) 547-8409

Fax

(509) 547-3751

NPI assigned

Jul 12, 2006

Organization subpart

No

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

Authorized official

Name

James C Sullivan, O.D.NPI 1992802656

Title

President

Phone

(509) 547-8409

Specialties & licenses 2

Addresses

Other identifiers 7

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• Direct secure messaging: pvc@direct.revolutionehr.com

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• James Chester Sullivan, O.D.

  • Optometrist
  • Pasco, WA
  • NPI 1992802656
  Medicare reassignment Care Compare group NPD Authorized official
• William Eugene Sullivan, O.D.

  • Optometrist
  • Pasco, WA
  • NPI 1265729354
  Medicare reassignment Care Compare group NPD
• Adam Dale Good, OD

  • Optometrist
  • Pasco, WA
  • NPI 1568661924
  Medicare reassignment Care Compare group
• Gerald L Wodtli, O.D.

  • Optometrist
  • Pasco, WA
  • NPI 1588699078
  NPD (past)

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781481600000",
    "number": "1104851690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2715 W COURT ST",
            "city": "PASCO",
            "state": "WA",
            "postal_code": "993013911",
            "telephone_number": "509-547-8409",
            "fax_number": "509-547-7875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2715 W COURT ST",
            "city": "PASCO",
            "state": "WA",
            "postal_code": "993013911",
            "telephone_number": "509-547-8409",
            "fax_number": "509-547-3751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PASCO VISION CLINIC P S",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2026-06-15",
        "certification_date": "2026-06-15",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "509-547-8409",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": "38",
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1265729354",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CK6046",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR & INDUSTRY",
            "identifier": "0056740",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1568661924",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1104851690",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2300028",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992802656",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pvc@direct.revolutionehr.com",
            "affiliation": "N",
            "address_1": "2715 W Court St",
            "city": "Pasco",
            "state": "WA",
            "country_code": "US",
            "postal_code": "993013911",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Hyung-Joo Park Park
• Lorin B Park, O.D.
• Pasco School District
• Pasco School District
• Pasco School District
• Latierney Patton, PMHNP
• PBS
• Peak Potential Psychology, PLLC
• Eric Pearson, P.A.
• Caleb Bradford Peck

• Optometrist in Pasco, WA
• Providers in Pasco, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.