NPIMap

Organization Active NPI

Pacific University

  • Optometrist
  • Cornelius, OR
National Provider Identifier
1124225842
Registry record updated Sep 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
PACIFIC UNIVERSITY
Practice address
1151 N Adair St Ste 104
Cornelius, OR 97113-8900
Phone
(503) 352-8543
Fax
(971) 266-2960
NPI assigned
Jun 27, 2007
Last updated
Sep 9, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
PACIFIC UNIVERSITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 9, 2026

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

Authorized official

Name
Lisa Downing
Title
Compliance Officer
Phone
(503) 352-2663

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OR Primary

Addresses

Primary practice location

1151 N Adair St Ste 104
Cornelius, OR 97113-8900

Mailing address

2043 College Way # A134
Forest Grove, OR 97116-1756
Phone (503) 352-8543

Other identifiers 1

IdentifierTypeStateIssuer
274669MedicaidOR

Other names 2

  • Pacific EyeClinic Cornelius Other name
  • Pacific University EyeClinic Cornelius Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031126000350 OR Part B Supplier - Clinic/Group Practice 0345144705 Receives reassigned benefits from 50 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hillsboro, OR; Portland, OR; Forest Grove, OR; Cornelius, OR; Beaverton, OR

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D2061874Pacific University Eye Clinic Cornelius1151 N Adair Street, Suite 104, Cornelius, OR 97113Certificate of waiverJul 7, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1182902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788912000000",
    "number": "1124225842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2043 COLLEGE WAY # A134",
            "city": "FOREST GROVE",
            "state": "OR",
            "postal_code": "971161756",
            "telephone_number": "503-352-8543",
            "fax_number": "971-266-2960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1151 N ADAIR ST STE 104",
            "city": "CORNELIUS",
            "state": "OR",
            "postal_code": "971138900",
            "telephone_number": "503-352-8543",
            "fax_number": "971-266-2960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC UNIVERSITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PACIFIC UNIVERSITY",
        "enumeration_date": "2007-06-27",
        "last_updated": "2026-09-09",
        "certification_date": "2026-09-09",
        "status": "A",
        "authorized_official_last_name": "DOWNING",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "503-352-2663"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "274669",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific EyeClinic Cornelius",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Pacific University EyeClinic Cornelius",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Cornelius, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 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.