Healthcare Provider Details

I. General information

NPI: 1417672999
Provider Name (Legal Business Name): PACIFIC OPTOMETRY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2022
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8952 SE SUNNYSIDE RD
CLACKAMAS OR
97015-9755
US

IV. Provider business mailing address

411 WALNUT ST # 24008
GREEN COVE SPRINGS FL
32043-3443
US

V. Phone/Fax

Practice location:
  • Phone: 503-659-0170
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: JENNA KOSKEY
Title or Position: OD
Credential:
Phone: 248-613-0225