Provider Demographics
NPI:1114978848
Name:PACIFIC CATARACT AND LASER INSTITUTE, INC., P.C.
Entity Type:Organization
Organization Name:PACIFIC CATARACT AND LASER INSTITUTE, INC., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-242-3008
Mailing Address - Street 1:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0409
Mailing Address - Country:US
Mailing Address - Phone:360-242-3008
Mailing Address - Fax:360-807-7687
Practice Address - Street 1:2517 NE KRESKY AVE
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532
Practice Address - Country:US
Practice Address - Phone:360-748-8632
Practice Address - Fax:360-748-3869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601 061 994261QA1903X, 261QS0132X
261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1870164OtherMEDICARE ID
WAG8853417OtherMEDICARE WA
WAG8858043OtherMEDICARE WA
WAGAB22210OtherMEDICARE WA
WAG0001615100OtherMEDICARE WA
G319000002OtherMEDICARE WA
MTM00005708OtherMEDICARE MT
ORR108010OtherMEDICARE OR
ORR147241OtherMEDICARE OR
WA7020712Medicaid
WA7144181Medicaid
WAG000100608OtherMEDICARE WA
WAG8893457OtherMEDICARE WA
WA7144132Medicaid
WA7144173Medicaid
WA7144215Medicaid
WAGAB22179OtherMEDICARE WA
WAGAB19549OtherMEDICARE WA
WA7144157Medicaid
WA7144165Medicaid
WAG000355050OtherMEDICARE WA
WAG8895424OtherMEDICARE WA
NMNMB2242OtherMEDICARE NM
MT000005708Medicare PIN
WA7144173Medicaid
WA7144132Medicaid
WA7020712Medicaid
WAG100608Medicare PIN
WAGAB22179Medicare PIN
WAG000165100Medicare PIN
ORR108010Medicare PIN