Healthcare Provider Details

I. General information

NPI: 1265609945
Provider Name (Legal Business Name): PACIFIC CATARACT AND LASER INSTITUTE, INC., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19801 SW 72ND AVE SUITE 150
TUALATIN OR
97062-8347
US

IV. Provider business mailing address

PO BOX 1506
CHEHALIS WA
98532-0409
US

V. Phone/Fax

Practice location:
  • Phone: 503-691-2283
  • Fax: 360-503-6915
Mailing address:
  • Phone: 360-242-3008
  • Fax: 360-807-7687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number071528
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number071528
License Number StateOR

VIII. Authorized Official

Name: CANDICE AUMAN
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 360-242-3265