NPIMap

Individual provider Active NPI

Terence O Tack, OD

  • Optometrist
  • Longview, WA
National Provider Identifier
1508925405
Registry record updated May 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OD00000948 Issued in WA
Practice address
820 Ocean Beach Hwy
Suite 100
Longview, WA 98632-4011
Phone
(360) 636-2020
NPI assigned
Dec 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2011

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

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OD00000948 WA Primary
Corneal and Contact Management Optometrist 152WC0802X OD00000948 WA
Low Vision Rehabilitation Optometrist 152WL0500X OD00000948 WA
Pediatric Optometrist 152WP0200X OD00000948 WA
Sports Vision Optometrist 152WS0006X OD00000948 WA
Vision Therapy Optometrist 152WV0400X OD00000948 WA
Occupational Vision Optometrist 152WX0102X OD00000948 WA

Addresses

Primary practice location

820 Ocean Beach Hwy
Suite 100
Longview, WA 98632-4011

Mailing address

820 Ocean Beach Hwy
Suite 100
Longview, WA 98632-4080
Phone (360) 636-2020

Other identifiers 3

IdentifierTypeStateIssuer
50D2022229OtherWACLIA #
410005544OtherWARAIL ROAD MEDICARE
2899201MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304294400000",
    "number": "1508925405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 OCEAN BEACH HWY",
            "address_2": "SUITE 100",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986324080",
            "telephone_number": "360-636-2020",
            "fax_number": "360-425-0221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 OCEAN BEACH HWY",
            "address_2": "SUITE 100",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986324011",
            "telephone_number": "360-636-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACK",
        "first_name": "TERENCE",
        "middle_name": "O",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-06",
        "last_updated": "2011-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD00000948",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "WA",
            "license": "OD00000948",
            "primary": false
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "WA",
            "license": "OD00000948",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "WA",
            "license": "OD00000948",
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "",
            "desc": "Optometrist, Sports Vision",
            "state": "WA",
            "license": "OD00000948",
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "WA",
            "license": "OD00000948",
            "primary": false
        },
        {
            "code": "152WX0102X",
            "taxonomy_group": "",
            "desc": "Optometrist, Occupational Vision",
            "state": "WA",
            "license": "OD00000948",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA #",
            "identifier": "50D2022229",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "410005544",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2899201",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.