Pacific University
Organization Active NPI Optometrist · Portland, OR
NPI 1497863104 · NPPES record last updated Nov 9, 2023
Key facts
- NPI
- 1497863104
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- PACIFIC UNIVERSITY
- Practice address
- 511 SW 10TH
Suite 500
Portland, OR 97205 - Phone
- (503) 352-2500
- Fax
- (503) 352-2523
- NPI assigned
- Aug 25, 2006
- Organization subpart
- No
Authorized official
- Name
- Alecia Neuman
- Title
- Director of Finance and Accounting
- Phone
- (503) 352-2951
Other NPIs on the same Medicare enrollment 8
Practitioners 7
-
Tad Willis Buckingham, O.D.
-
Dina H Erickson, O.D.
-
Matthew J Lampa, O.D.
-
Neeru Verma Shore, O.D.
-
William F Hefner, O.D.
-
Maggie Man Ki Ho, OD, MS, FAAO
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Locations
511 SW 10th Ave
Ste 500
Portland, OR 97205
Phone (503) 224-2323
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
511 SW 10TH
Suite 500
Portland, OR 97205
Mailing address
2043 College Way BLDG 2221
Forest Grove, OR 97116-1756
Phone (503) 352-2500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 142984 | Medicaid | OR |
Other names
- Pacific University EyeClinic Portland
Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 9, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.