Organization
LONGVIEW EYE & VISION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERENCE ORMAL TACK OD (OPTOMETRIST-OWNER)
(360) 636-2020
Entity
Organization
Contact information
Practice address
820 OCEAN BEACH HWY, SUITE 100, LONGVIEW, WA 98632-4011
(360) 636-2020
(360) 425-0221
Mailing address
820 OCEAN BEACH HWY, SUITE 100, LONGVIEW, WA 98632-4011
(360) 636-2020
(360) 425-0221
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
—
—
332H00000X
Eyewear Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2021921
—
WA
01
—
410024013
RAIL ROAD MEDICARE
WA
01
—
50D2022229
CLIA#
WA
Enumeration date
02/15/2007
Last updated
04/27/2017
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