1538336219 NPI number — PACIFIC CATARACT AND LASER INSTITUTE INC PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538336219 NPI number — PACIFIC CATARACT AND LASER INSTITUTE INC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFIC CATARACT AND LASER INSTITUTE INC 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:
1538336219
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:
3900 KERN WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-7803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-966-1356
Provider Business Practice Location Address Fax Number:
509-966-5101
Provider Enumeration Date:
05/13/2008

Additional Information

Authorized Official

Authorized Official Last Name:
AUMAN
Authorized Official First Name:
CANDICE
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:  601061994 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QS0132X , with the licence number: 601061994 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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