Provider Demographics
NPI:1124319009
Name:PACIFIC UNIVERSITY
Entity type:Organization
Organization Name:PACIFIC UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE & ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGSTRAAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-352-1621
Mailing Address - Street 1:12600 SW CRESCENT ST
Mailing Address - Street 2:130
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-1693
Mailing Address - Country:US
Mailing Address - Phone:503-352-2020
Mailing Address - Fax:503-352-2261
Practice Address - Street 1:12600 SW CRESCENT ST
Practice Address - Street 2:130
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-1693
Practice Address - Country:US
Practice Address - Phone:503-352-2020
Practice Address - Fax:971-266-2963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty