NPIMap

Organization Active NPI

Woodland Eye & Vision

  • Optometrist
  • Woodland, WA
National Provider Identifier
1215063516
Registry record updated Apr 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
WOODLAND EYE & VISION
Practice address
500 Columbia St
Suite a
Woodland, WA 98674-8491
Phone
(360) 225-1010
Fax
(360) 225-1730
NPI assigned
Feb 23, 2007
Last updated
Apr 8, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
LONGVIEW EYE & VISIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 8, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jeffrey Scott Tack, ODNPI 1710046610
Title
Optometrist-Owner
Phone
(360) 225-1010

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X Primary
Corneal and Contact Management OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152WC0802X
Low Vision Rehabilitation OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152WL0500X
Pediatric OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152WP0200X
Sports Vision OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152WS0006X
Vision Therapy OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152WV0400X
Occupational Vision OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152WX0102X

Addresses

Primary practice location

500 Columbia St
Suite a
Woodland, WA 98674-8491

Mailing address

500 Columbia St
Suite a
Woodland, WA 98674-8491
Phone (360) 225-1010

Other identifiers 2

IdentifierTypeStateIssuer
410024013OtherWARAILROAD MEDICARE
2021772MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040212000863 WA Part B Supplier - Clinic/Group Practice 5395639959 Receives reassigned benefits from 5 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cathlamet, WA; Longview, WA; Woodland, WA

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Woodland Eye Vision3 organizations share this tax ID, including this one
Part of
Woodland Eye Vision

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

500 Columbia St
Ste A
Woodland, WA 98674
Phone (360) 225-1010

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365379200000",
    "number": "1215063516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 COLUMBIA ST",
            "address_2": "SUITE A",
            "city": "WOODLAND",
            "state": "WA",
            "postal_code": "986748491",
            "telephone_number": "360-225-1010",
            "fax_number": "360-225-1730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 COLUMBIA ST",
            "address_2": "SUITE A",
            "city": "WOODLAND",
            "state": "WA",
            "postal_code": "986748491",
            "telephone_number": "360-225-1010",
            "fax_number": "360-225-1730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODLAND EYE & VISION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LONGVIEW  EYE & VISION",
        "enumeration_date": "2007-02-23",
        "last_updated": "2013-04-08",
        "status": "A",
        "authorized_official_last_name": "TACK",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "OPTOMETRIST-OWNER",
        "authorized_official_telephone_number": "360-225-1010",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Sports Vision",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Vision Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WX0102X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Occupational Vision",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "410024013",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2021772",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodland, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.