MEDICARE: PACIFIC EYE CARE OF POULSBO PS

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist		WA
2	207W00000X	Ophthalmology Physician	MD00029555	WA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	G115140600	OTHER	WA	MEDICARE PART B

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1205825262
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC EYE CARE OF POULSBO PS

Provider Business Mailing Address
First Line	:	20669 BOND RD NE
Second Line	:	STE 100
City	:	POULSBO
State	:	WA
Zip	:	98370-6525
Country	:	US
Telephone Number	:	360-779-2020
Fax Number	:	360-779-3093

Provider Business Practice Location Address
First Line	:	20669 BOND RD NE
Second Line	:	STE 100
City	:	POULSBO
State	:	WA
Zip	:	98370-6525
Country	:	US
Telephone Number	:	360-779-2020
Fax Number	:	360-779-3093

Authorized Official
Title or Position	:	OPTHALMOLOGIST
Name	:	DR. JAMES LIN
Credential	:
Telephone Number	:	360-779-2020

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	09/22/2021

20669 BOND RD NE , SUITE 200
POULSBO, WA
98370-6525

Practice Phone: 360-779-6527
Practice Fax: 360-697-2743

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