Provider Demographics
NPI:1497863104
Name:PACIFIC UNIVERSITY
Entity Type:Organization
Organization Name:PACIFIC UNIVERSITY
Other - Org Name:PACIFIC UNIVERSITY EYECLINIC PORTLAND
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF FINANCE AND ACCOUNTING
Authorized Official - Prefix:
Authorized Official - First Name:ALECIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-352-2951
Mailing Address - Street 1:2043 COLLEGE WAY BLDG 2221
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-1756
Mailing Address - Country:US
Mailing Address - Phone:503-352-2500
Mailing Address - Fax:971-226-2964
Practice Address - Street 1:511 SW 10TH
Practice Address - Street 2:SUITE 500
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205
Practice Address - Country:US
Practice Address - Phone:503-352-2500
Practice Address - Fax:503-352-2523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR142984Medicaid
0000WCJSBMedicare ID - Type Unspecified