Healthcare Provider Details

I. General information

NPI: 1659548329
Provider Name (Legal Business Name): PACIFIC CATARACT AND LASER INSTITUTE INC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9309 NE 86TH ST
VANCOUVER WA
98662-2100
US

IV. Provider business mailing address

PO BOX 1506
CHEHALIS WA
98532-0409
US

V. Phone/Fax

Practice location:
  • Phone: 360-694-2544
  • Fax: 360-807-7687
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 Number601061994
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number601061994
License Number StateWA

VIII. Authorized Official

Name: CANDICE AUMAN
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 360-242-3008