NPIMap

Organization Active NPI

Pacific Eye Care of Poulsbo PS

  • Ophthalmology Physician
  • Poulsbo, WA
National Provider Identifier
1205825262
Registry record updated Sep 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
MD00029555 Issued in WA
Legal business name
PACIFIC EYE CARE OF POULSBO PS
Practice address
20669 Bond Rd NE
Ste 100
Poulsbo, WA 98370-6525
Phone
(360) 779-2020
Fax
(360) 779-3093
NPI assigned
Oct 20, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2021

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

Authorized official

Name
Dr. James LinNPI 1821085846
Title
Opthalmologist
Phone
(360) 779-2020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X WA
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X MD00029555 WA Primary

Addresses

Primary practice location

20669 Bond Rd NE
Ste 100
Poulsbo, WA 98370-6525

Mailing address

20669 Bond Rd NE
Ste 100
Poulsbo, WA 98370-6525
Phone (360) 779-2020

Other identifiers 3

IdentifierTypeStateIssuer
2018968MedicaidWA
7074982MedicaidWA
G115140600OtherWAMEDICARE PART B

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040303000375 WA Part B Supplier - Clinic/Group Practice 6709773807 Receives reassigned benefits from 6 practitioners
Practice locations: Port Townsend, WA; Poulsbo, WA

National Provider Directory

National Provider Directory
Tax ID family
Pacific Eyecare of Poulsbo4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Interoperability endpoints

  • Direct secure messaging: jlin@pacificeyecare.intellechartdirect.net
  • Direct secure messaging: anoble@pacificeyecare.intellechartdirect.net
  • Direct secure messaging: cnathe@pacificeyecare.intellechartdirect.net

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1129766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632268800000",
    "number": "1205825262",
    "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": "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC EYE CARE OF POULSBO PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-20",
        "last_updated": "2021-09-22",
        "certification_date": "2021-09-22",
        "status": "A",
        "authorized_official_last_name": "LIN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "OPTHALMOLOGIST",
        "authorized_official_telephone_number": "360-779-2020",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "WA",
            "license": "MD00029555",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2018968",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7074982",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B",
            "identifier": "G115140600",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Poulsbo, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.