Pacific Vision Medical Center

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

ZZZ28910Z Issued in CA

Legal business name

PACIFIC VISION MEDICAL CENTER

Practice address

515 E Washington Blvd
Crescent City, CA 95531-8342

Phone

(707) 465-2020

Fax

(707) 465-6252

NPI assigned

Jan 9, 2007

Last updated

Jun 29, 2020By 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

Larry A Eninger, M.D.NPI 1972588168

Title

Partner

Phone

(707) 465-2020

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

Practitioners 1

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.

• Larry Allen Eninger, M.D.

  • Ophthalmology Physician
  • Crescent City, CA
  • NPI 1972588168
  Authorized official Same address or phone

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593388800000",
    "number": "1346399433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 E WASHINGTON BLVD",
            "city": "CRESCENT CITY",
            "state": "CA",
            "postal_code": "955318342",
            "telephone_number": "707-465-2020",
            "fax_number": "707-465-6252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 E WASHINGTON BLVD",
            "city": "CRESCENT CITY",
            "state": "CA",
            "postal_code": "955318342",
            "telephone_number": "707-465-2020",
            "fax_number": "707-465-6252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC VISION MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2020-06-29",
        "certification_date": "2020-06-29",
        "status": "A",
        "authorized_official_last_name": "ENINGER",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "707-465-2020",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "CA",
            "license": "0534820001",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "ZZZ28910Z",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "ZZZ28910Z",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0052190",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "larryeninger@direct-address.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "515 E Washington Blvd",
            "city": "Crescent City",
            "state": "CA",
            "country_code": "US",
            "postal_code": "955318342",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Alissa Michelle Oulman-Kirkpatrick, IBCLC
• Frank Oxford, RN
• Pacific Coast Allergy
• Pacific Northwest Physical Therapy
• Pacific Northwest Physical Therapy
• Pacific Vision Medical Center
• Marcus T Padilla
• Erica Tiffany Page, MSW, PPSC-SSW
• Karen Ellen Painter
• Raquel Gabriela Pamplona Da Silva

• Ophthalmology Physician in Crescent City, CA
• Providers in Crescent City, CA by specialty
• Ophthalmology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2020; 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.