NPIMap

Organization Active NPI

Pacific University

  • Optometrist
  • Forest Grove, OR
National Provider Identifier
1386292852
Registry record updated Nov 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
PACIFIC UNIVERSITY
Practice address
2043 College Way
Forest Grove, OR 97116-1797
Phone
(503) 352-2020
Fax
(503) 352-2046
NPI assigned
Aug 28, 2019
Last updated
Nov 14, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2023

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU
Optometrist 152W00000X NU Primary
Pediatric Optometrist 152WP0200X NU

Addresses

Primary practice location

2043 College Way
Forest Grove, OR 97116-1797

Mailing address

2043 College Way
Forest Grove, OR 97116-1797
Phone (503) 352-2020

Other identifiers 1

IdentifierTypeStateIssuer
500778799MedicaidOR

Other names 1

  • Pacific University Mobile EyeVan Other name

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
38D1066590Pacific University College of Optometry2043 College Way, Forest Grove, OR 97116Certificate of waiverMar 27, 2027

National Provider Directory

National Provider Directory
Tax ID family
Pacific U Center for Si9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

NPI Registry JSON

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

{
    "created_epoch": "1566950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699920000000",
    "number": "1386292852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2043 COLLEGE WAY",
            "city": "FOREST GROVE",
            "state": "OR",
            "postal_code": "971161797",
            "telephone_number": "503-352-2020",
            "fax_number": "503-352-2046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2043 COLLEGE WAY",
            "city": "FOREST GROVE",
            "state": "OR",
            "postal_code": "971161797",
            "telephone_number": "503-352-2020",
            "fax_number": "503-352-2046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-28",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "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": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500778799",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific University Mobile EyeVan",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Forest Grove, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.