1114978848 NPI number — PACIFIC CATARACT AND LASER INSTITUTE, INC., P.C.

Table of content: (NPI 1114978848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114978848 NPI number — PACIFIC CATARACT AND LASER INSTITUTE, INC., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFIC CATARACT AND LASER INSTITUTE, INC., P.C.
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:
1114978848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1506
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHEHALIS
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98532-0409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-242-3008
Provider Business Mailing Address Fax Number:
360-807-7687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2517 NE KRESKY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHEHALIS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-748-8632
Provider Business Practice Location Address Fax Number:
360-748-3869
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PEARSON
Authorized Official First Name:
DARLA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
360-242-3008

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  601 061 994 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QS0132X , with the licence number: 601 061 994 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1870164 . This is a "MEDICARE ID" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: G8853417 . This is a "MEDICARE WA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: G8858043 . This is a "MEDICARE WA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: GAB22210 . This is a "MEDICARE WA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: G0001615100 . This is a "MEDICARE WA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: G319000002 . This is a "MEDICARE WA" identifier . This identifiers is of the category "OTHER".
  • Identifier: M00005708 . This is a "MEDICARE MT" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: R108010 . This is a "MEDICARE OR" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: R147241 . This is a "MEDICARE OR" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 7020712 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7144181 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: G000100608 . This is a "MEDICARE WA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: G8893457 . This is a "MEDICARE WA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7144132 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7144173 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7144215 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GAB22179 . This is a "MEDICARE WA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: GAB19549 . This is a "MEDICARE WA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7144157 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7144165 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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