Organization
WOODLAND EYE & VISION
Active
Parent organization
LONGVIEW EYE & VISION
Organization subpart
Yes
Provider details
NPI number
Legal business name
LONGVIEW EYE & VISION
Authorized official
JEFFREY SCOTT TACK OD (OPTOMETRIST-OWNER)
(360) 225-1010
Entity
Organization
Contact information
Practice address
500 COLUMBIA ST, SUITE A, WOODLAND, WA 98674-8491
(360) 225-1010
(360) 225-1730
Mailing address
500 COLUMBIA ST, SUITE A, WOODLAND, WA 98674-8491
(360) 225-1010
(360) 225-1730
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
152WC0802X
Corneal and Contact Management Optometrist
—
—
152WL0500X
Low Vision Rehabilitation Optometrist
—
—
152WP0200X
Pediatric Optometrist
—
—
152WS0006X
Sports Vision Optometrist
—
—
152WV0400X
Vision Therapy Optometrist
—
—
152WX0102X
Occupational Vision Optometrist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2021772
—
WA
01
—
410024013
RAILROAD MEDICARE
WA
Enumeration date
02/23/2007
Last updated
04/08/2013
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