Healthcare Provider Details

I. General information

NPI: 1912467226
Provider Name (Legal Business Name): PACIFIC EYE GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 NW EASTMAN PKWY
GRESHAM OR
97030-5533
US

IV. Provider business mailing address

175 E HOUSTON ST
SAN ANTONIO TX
78205-2255
US

V. Phone/Fax

Practice location:
  • Phone: 503-666-7460
  • Fax: 503-667-8006
Mailing address:
  • Phone: 726-444-4172
  • Fax: 210-524-6587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: THOMPSON SOWASH
Title or Position: OWNER
Credential:
Phone: 726-444-4172