Tack, Jeffrey S

Tack, Jeffrey S is an individual health care provider with primary practice located at 820 Ocean Beach Hwy Suite 100, Longview WA 98632-4011. He recently has 7 registered licenses in different health care specialties including Eye and Vision Services Providers / Optometrist, Eye and Vision Services Providers / Corneal and Contact Management, Eye and Vision Services Providers / Low Vision Rehabilitation, Eye and Vision Services Providers / Pediatrics, Eye and Vision Services Providers / Sports Vision, Eye and Vision Services Providers / Vision Therapy, Eye and Vision Services Providers / Occupational Vision. Eye and Vision Services Providers / Optometrist is his primary health care specialty. Tack, Jeffrey S can be contacted via phone (360) 636-2020.

Contact Information

Primary practice address
820 Ocean Beach Hwy Suite 100 Longview WA 98632-4011
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X OD00002037 Washington
Eye and Vision Services Providers / Corneal and Contact Management 152WC0802X OD00002037 Washington
Eye and Vision Services Providers / Low Vision Rehabilitation 152WL0500X OD00002037 Washington
Eye and Vision Services Providers / Pediatrics 152WP0200X OD00002037 Washington
Eye and Vision Services Providers / Sports Vision 152WS0006X OD00002037 Washington
Eye and Vision Services Providers / Vision Therapy 152WV0400X OD00002037 Washington
Eye and Vision Services Providers / Occupational Vision 152WX0102X OD00002037 Washington

Profile Details

NPI number 1710046610
LBN Legal business name Tack, Jeffrey S
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 6th, 2006
Last updated May 2nd, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1710046610 NPPES
Washington Other 410024013 RAIL ROAD MEDICARE
Washington MEDICAID 2013696 RAIL ROAD MEDICARE
Washington Other 50D2022229 RAIL ROAD MEDICARE

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