Healthcare Provider Details

I. General information

NPI: 1205825262
Provider Name (Legal Business Name): PACIFIC EYE CARE OF POULSBO PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20669 BOND RD NE STE 100
POULSBO WA
98370-6525
US

IV. Provider business mailing address

20669 BOND RD NE STE 100
POULSBO WA
98370-6525
US

V. Phone/Fax

Practice location:
  • Phone: 360-779-2020
  • Fax: 360-779-3093
Mailing address:
  • Phone: 360-779-2020
  • Fax: 360-779-3093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD00029555
License Number StateWA

VIII. Authorized Official

Name: DR. JAMES LIN
Title or Position: OPTHALMOLOGIST
Credential:
Phone: 360-779-2020