Provider Demographics
NPI:1831656925
Name:PACIFIC EYE GROUP, PC
Entity Type:Organization
Organization Name:PACIFIC EYE GROUP, PC
Other - Org Name:PACIFIC EYE GROUP, PC
Other - Org Type:Doing Business As
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:OD
Authorized Official - Phone:303-552-7139
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:726-444-4078
Mailing Address - Fax:210-524-6587
Practice Address - Street 1:63455 N HWY 97 STE 75
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-6761
Practice Address - Country:US
Practice Address - Phone:541-389-5207
Practice Address - Fax:541-389-2718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-25
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty