NPIMap

Organization Active NPI

Pacific Eye Group, PC

  • Optometrist
  • Beaverton, OR
National Provider Identifier
1477175453
Registry record updated May 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
PACIFIC EYE GROUP, PC
Practice address
3205 SW Cedar Hills Blvd Ste 9
Beaverton, OR 97005-1347
Phone
(503) 469-1391
Fax
(503) 646-2426
NPI assigned
May 12, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2020

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

Authorized official

Name
Dolsie McDonald
Title
Credentialing Manager
Phone
(726) 444-4545

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

3205 SW Cedar Hills Blvd Ste 9
Beaverton, OR 97005-1347

Mailing address

175 E Houston St
San Antonio, TX 78205-2255
Phone (800) 340-0129

National Provider Directory

National Provider Directory
Tax ID family
Pacific Eye Group PC15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Practitioners & affiliated clinicians

Practitioners 1

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": "1589241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589241600000",
    "number": "1477175453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 E HOUSTON ST",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782052255",
            "telephone_number": "800-340-0129",
            "fax_number": "210-524-6587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3205 SW CEDAR HILLS BLVD STE 9",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970051347",
            "telephone_number": "503-469-1391",
            "fax_number": "503-646-2426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC EYE GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-12",
        "last_updated": "2020-05-12",
        "certification_date": "2020-05-12",
        "status": "A",
        "authorized_official_last_name": "MCDONALD",
        "authorized_official_first_name": "DOLSIE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "726-444-4545"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 May 12, 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.