Organization
ALL FAMILY VISION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUSTIN HEINTZ OD (OWNER)
(541) 757-8844
Entity
Organization
Contact information
Practice address
1597 SW 53RD ST, CORVALLIS, OR 97333-2630
(541) 757-8844
Mailing address
1597 SW 53RD ST, CORVALLIS, OR 97333-2630
(541) 757-8844
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2515T
OR
152W00000X
Optometrist
3307ATI
OR
332H00000X
Eyewear Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R163171
MEDICARE PTAN
OR
01
—
R163394
MEDICARE PTAN
OR
Enumeration date
12/29/2011
Last updated
08/12/2019
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