MEDICARE: PACIFIC UNIVERSITY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	152WP0200X	Pediatric Optometrist
2	261Q00000X	Clinic/Center
3	152W00000X	Optometrist

Other Identifiers

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

General Provider Information

NPI Number	:	1386292852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC UNIVERSITY

Provider Business Mailing Address
First Line	:	2043 COLLEGE WAY
Second Line	:
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-1797
Country	:	US
Telephone Number	:	503-352-2020
Fax Number	:	503-352-2046

Provider Business Practice Location Address
First Line	:	2043 COLLEGE WAY
Second Line	:
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-1797
Country	:	US
Telephone Number	:	503-352-2020
Fax Number	:	503-352-2046

Authorized Official
Title or Position	:	COMPLIANCE OFFICER
Name	:	LISA DOWNING
Credential	:
Telephone Number	:	503-352-2663

Provider Enumeration Date	:	08/28/2019
Last Update Date	:	11/14/2023

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Directions to “PACIFIC UNIVERSITY ” Practice Location

Language	Start Address	Practice Location

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