Provider Demographics
NPI:1609336916
Name:PACIFIC EYE GROUP, PC
Entity Type:Organization
Organization Name:PACIFIC EYE GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMPSON
Authorized Official - Middle Name:
Authorized Official - Last Name:SOWASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:726-444-4172
Mailing Address - Street 1:175 E HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-2255
Mailing Address - Country:US
Mailing Address - Phone:726-444-4172
Mailing Address - Fax:
Practice Address - Street 1:30020 SW BOONES FERRY RD STE 10
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-8912
Practice Address - Country:US
Practice Address - Phone:503-570-0963
Practice Address - Fax:503-570-4354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty