NPIMap

Organization Active NPI

Longview Eye & Vision

  • Optometrist
  • Longview, WA
National Provider Identifier
1861535197
Registry record updated Apr 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
LONGVIEW EYE & VISION
Practice address
820 Ocean Beach Hwy
Suite 100
Longview, WA 98632-4011
Phone
(360) 636-2020
Fax
(360) 425-0221
NPI assigned
Feb 15, 2007
Last updated
Apr 27, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2017

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

Authorized official

Name
Terence Ormal Tack, ODNPI 1508925405
Title
Optometrist-Owner
Phone
(360) 636-2020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X
Optometrist 152W00000X Primary
Corneal and Contact Management Optometrist 152WC0802X
Low Vision Rehabilitation Optometrist 152WL0500X
Pediatric Optometrist 152WP0200X
Sports Vision Optometrist 152WS0006X
Vision Therapy Optometrist 152WV0400X
Occupational Vision Optometrist 152WX0102X

Addresses

Primary practice location

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

Mailing address

820 Ocean Beach Hwy
Suite 100
Longview, WA 98632-4011
Phone (360) 636-2020

Other identifiers 3

IdentifierTypeStateIssuer
2021921MedicaidWA
410024013OtherWARAIL ROAD MEDICARE
50D2022229OtherWACLIA#

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

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
Practice locations: Cathlamet, WA; Longview, WA; Woodland, WA
O20100930017800 WA DME Supplier - Physician - OptometristDME Supplier - Optician 5395639959 Practice locations: Longview, WA

Other NPIs on the same Medicare enrollment 2

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D2022229Longview Eye and Vision820 Ocean Beach Hwy Ste 100, Longview, WA 98632Certificate of waiverApr 4, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Longview Eye & Vision820 Ocean Beach Hwy, Longview, WA 98632-4081(360) 636-2020 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Jan 1, 1998

National Provider Directory

National Provider Directory
Tax ID family
Longview Eye and Vision3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

1000 12th Ave
Ste 1
Longview, WA 98632
Phone (360) 425-0220

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 6

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": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493251200000",
    "number": "1861535197",
    "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": "986324011",
            "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",
            "fax_number": "360-425-0221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGVIEW EYE & VISION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-15",
        "last_updated": "2017-04-27",
        "status": "A",
        "authorized_official_last_name": "TACK",
        "authorized_official_first_name": "TERENCE",
        "authorized_official_middle_name": "ORMAL",
        "authorized_official_title_or_position": "OPTOMETRIST-OWNER",
        "authorized_official_telephone_number": "360-636-2020",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "",
            "desc": "Optometrist, Sports Vision",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WX0102X",
            "taxonomy_group": "",
            "desc": "Optometrist, Occupational Vision",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2021921",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "410024013",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA#",
            "identifier": "50D2022229",
            "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 Apr 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.