Jeffrey S Tack, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD00002037 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

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

Specialties & licenses 7

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Pacific University - College of Optometry, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Longview Eye and VisionGroup PAC ID 5395639959, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Longview Eye & Vision

  • Optometrist
  • Longview, WA
  • NPI 1861535197
  Medicare reassignment Care Compare group NPD
• Woodland Eye & Vision

  • Optometrist
  • Woodland, WA
  • NPI 1215063516
  NPD Authorized official
• Longview Eye & Vision

  • Optometrist
  • Cathlamet, WA
  • NPI 1811023732
  NPD

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": "1710046610",
    "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": "JEFFREY",
        "middle_name": "S",
        "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": "OD00002037",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "WA",
            "license": "OD00002037",
            "primary": false
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "WA",
            "license": "OD00002037",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "WA",
            "license": "OD00002037",
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "",
            "desc": "Optometrist, Sports Vision",
            "state": "WA",
            "license": "OD00002037",
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "WA",
            "license": "OD00002037",
            "primary": false
        },
        {
            "code": "152WX0102X",
            "taxonomy_group": "",
            "desc": "Optometrist, Occupational Vision",
            "state": "WA",
            "license": "OD00002037",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "410024013",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2013696",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA#",
            "identifier": "50D2022229",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley A Swofford, MSW, LICSWA
• Savanna Swogger
• Synergy Health Solutions, PC
• Breann Lynn Syron, RN
• Hassan H Tabrizi, MD
• Terence O Tack, OD
• Annette Allison Tacke, RDH
• Wendy Rossana Tacuba Chavelas, PHARMD
• Dwight Christian Tan, PA-C
• Jessela D. Tan, M.D.

• Optometrist in Longview, WA
• Providers in Longview, WA by specialty
• Optometrist in Washington

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.