NPIMap

Organization Active NPI

Pacific University

  • Optometrist
  • Beaverton, OR
National Provider Identifier
1124319009
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
12600 SW Crescent St
130
Beaverton, OR 97005-1693
Phone
(503) 352-2020
Fax
(971) 266-2963
NPI assigned
Apr 26, 2011
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
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

12600 SW Crescent St
130
Beaverton, OR 97005-1693

Mailing address

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

Other names 2

  • Pacific EyeClinic Beaverton Other name
  • Pacific University EyeClinic Beaverton 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
38D2061876Pacific University Eye Clinic Beaverton12600 SW Crescent Street, Suite 130, Beaverton, OR 97005Certificate of waiverJul 7, 2027

National Provider Directory

National Provider Directory
Tax ID family
Pacific Uni Optometric9 organizations share this tax ID, including this one
Part of
Pacific Uni Optometric

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1151 N Adair St
Ste 104
Cornelius, OR 97113
Phone (503) 352-8543

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1303776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788912000000",
    "number": "1124319009",
    "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": "503-352-2046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12600 SW CRESCENT ST",
            "address_2": "130",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970051693",
            "telephone_number": "503-352-2020",
            "fax_number": "971-266-2963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC UNIVERSITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PACIFIC UNIVERSITY",
        "enumeration_date": "2011-04-26",
        "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": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific EyeClinic Beaverton",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Pacific University EyeClinic Beaverton",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Beaverton, 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.