Lighthouse Vision Care, P.C.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2858T Issued in OR

Legal business name

LIGHTHOUSE VISION CARE, P.C.

Practice address

310 Stillwell Ave
Tillamook, OR 97141-2119

Phone

(503) 842-6363

Fax

(503) 842-6204

NPI assigned

Sep 24, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Raymond K Dehaan, O.D.NPI 1639221690

Title

Optometrist/President

Phone

(503) 842-6363

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Raymond Keith Dehaan, O.D.

  • Pediatric Optometrist
  • Tillamook, OR
  • NPI 1639221690
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1190592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190592000000",
    "number": "1235325176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 STILLWELL AVE",
            "city": "TILLAMOOK",
            "state": "OR",
            "postal_code": "971412119",
            "telephone_number": "503-842-6363",
            "fax_number": "503-842-6204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 STILLWELL AVE",
            "city": "TILLAMOOK",
            "state": "OR",
            "postal_code": "971412119",
            "telephone_number": "503-842-6363",
            "fax_number": "503-842-6204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHOUSE VISION CARE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-24",
        "last_updated": "2007-09-24",
        "status": "A",
        "authorized_official_last_name": "DEHAAN",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OPTOMETRIST/PRESIDENT",
        "authorized_official_telephone_number": "503-842-6363",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "OR",
            "license": "2858T",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "OR",
            "license": "2858T",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Pediatrics",
            "state": "OR",
            "license": "2858T",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182762",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cheryl Lynn Krueger, MOT, OTR/L
• Shawn Nicolle Kuehl, FNP
• Joseph J Lamartina, CADC II
• Merrilee Lane
• Steven Doug Larzelier, LCSW
• Lee C Long, DDS
• Susan Joy Long, LMFT
• Karolin H Lopera
• Yazmina Lopez, LCSW
• Sarah Luker

• Optometrist in Tillamook, OR
• Providers in Tillamook, OR by specialty
• Optometrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2007; 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.