Provider Demographics
NPI:1205825262
Name:PACIFIC EYE CARE OF POULSBO PS
Entity Type:Organization
Organization Name:PACIFIC EYE CARE OF POULSBO PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-779-2020
Mailing Address - Street 1:20669 BOND RD NE
Mailing Address - Street 2:STE 100
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-6525
Mailing Address - Country:US
Mailing Address - Phone:360-779-2020
Mailing Address - Fax:360-779-3093
Practice Address - Street 1:20669 BOND RD NE
Practice Address - Street 2:STE 100
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6525
Practice Address - Country:US
Practice Address - Phone:360-779-2020
Practice Address - Fax:360-779-3093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA152W00000X
WAMD00029555207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2018968Medicaid
WA7074982Medicaid
WAG115140600OtherMEDICARE PART B
WAG115140600OtherMEDICARE PART B
E46615Medicare UPIN