1629626544 NPI number — PACIFIC EYE GROUP, PC.

Table of content: (NPI 1629626544)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629626544 NPI number — PACIFIC EYE GROUP, PC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFIC EYE GROUP, PC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629626544
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
175 E HOUSTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78205-2255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
726-444-4172
Provider Business Mailing Address Fax Number:
210-524-6587

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
265 VALLEY RIVER CTR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97401-2176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-684-3924
Provider Business Practice Location Address Fax Number:
541-684-3926
Provider Enumeration Date:
09/04/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SOWASH
Authorized Official First Name:
THOMPSON
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
726-444-4172

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)