Tack, Terence O
Tack, Terence O 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, Terence O can be contacted via phone (360) 636-2020.Contact Information
Primary practice address
820 Ocean Beach Hwy Suite 100
Longview WA 98632-4011
Phone: (360) 636-2020
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | OD00000948 | Washington |
| Eye and Vision Services Providers / Corneal and Contact Management | 152WC0802X | OD00000948 | Washington |
| Eye and Vision Services Providers / Low Vision Rehabilitation | 152WL0500X | OD00000948 | Washington |
| Eye and Vision Services Providers / Pediatrics | 152WP0200X | OD00000948 | Washington |
| Eye and Vision Services Providers / Sports Vision | 152WS0006X | OD00000948 | Washington |
| Eye and Vision Services Providers / Vision Therapy | 152WV0400X | OD00000948 | Washington |
| Eye and Vision Services Providers / Occupational Vision | 152WX0102X | OD00000948 | Washington |
Profile Details
| NPI number | 1508925405 |
|---|---|
| LBN Legal business name | Tack, Terence O |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 6th, 2006 |
| Last updated | May 2nd, 2011 - about 14 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1508925405 | NPPES |
| Washington | Other | 50D2022229 | CLIA # |
| Washington | Other | 410005544 | CLIA # |
| Washington | MEDICAID | 2899201 | CLIA # |
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