NPIMap

Organization Active NPI

Pacific Eye Care of Poulsbo PS

Doing business as Pacific Optical

  • Eyewear Supplier
  • PT Orchard, WA
National Provider Identifier
1811986870
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
License
MD00029555 Issued in WA
Legal business name
PACIFIC EYE CARE OF POULSBO PS
Doing business as
Pacific Optical
Practice address
1135 Bethel Ave
PT Orchard, WA 98366-3125
Phone
(360) 895-2020
Fax
(360) 874-0048
NPI assigned
Oct 20, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
David JC OmorchoeNPI 1073509899
Title
MD/Owner
Phone
(360) 779-2020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X MD00029555 WA Primary

Addresses

Primary practice location

1135 Bethel Ave
PT Orchard, WA 98366-3125

Mailing address

20669 Bond Rd NE
Ste 100
Poulsbo, WA 98370-6525
Phone (360) 779-3093

Other identifiers 1

IdentifierTypeStateIssuer
2025633MedicaidWA

Other names 1

  • Pacific Optical Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pacific Eye Care 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.

Practitioners & affiliated clinicians

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.

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": "1598054400000",
    "number": "1811986870",
    "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": "360-779-3093",
            "fax_number": "360-779-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1135 BETHEL AVE",
            "city": "PT ORCHARD",
            "state": "WA",
            "postal_code": "983663125",
            "telephone_number": "360-895-2020",
            "fax_number": "360-874-0048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC EYE CARE OF POULSBO PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "OMORCHOE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "JC",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "360-779-2020"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "WA",
            "license": "MD00029555",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2025633",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific Optical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in PT Orchard, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.