JEFFREY S TACK (NPI# 1710046610) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710046610 |
| Entity Type | Individual |
| Full Name | JEFFREY S TACK |
| Credential | OD |
| Practice Address |
820 Ocean Beach Hwy Suite 100 Longview WA 98632-4011 |
| Mailing Address |
820 Ocean Beach Hwy Suite 100 Longview WA 98632-4080 |
| Practice Telephone | 3606362020 |
| Mailing Telephone | 3606362020 |
| Mailing Fax Number | 3604250221 |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2011-05-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | OD00002037 | WA | Eye and Vision Services Providers |
| N | 152WC0802X |
Optometrist Specialization: Corneal and Contact Management |
OD00002037 | WA | Eye and Vision Services Providers |
| N | 152WL0500X |
Optometrist Specialization: Low Vision Rehabilitation |
OD00002037 | WA | Eye and Vision Services Providers |
| N | 152WP0200X |
Optometrist Specialization: Pediatrics |
OD00002037 | WA | Eye and Vision Services Providers |
| N | 152WS0006X |
Optometrist Specialization: Sports Vision |
OD00002037 | WA | Eye and Vision Services Providers |
| N | 152WV0400X |
Optometrist Specialization: Vision Therapy |
OD00002037 | WA | Eye and Vision Services Providers |
| N | 152WX0102X |
Optometrist Specialization: Occupational Vision |
OD00002037 | WA | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 2013696 | 05 | |
| WA | CLIA# | 50D2022229 | 01 |
| WA | RAIL ROAD MEDICARE | 410024013 | 01 |
| Street Address |
820 OCEAN BEACH HWY SUITE 100 |
| City | LONGVIEW |
| State | WA |
| Zip Code | 98632-4011 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285093385 | Smiles Dental Group, PC | Dentist | 820 Ocean Beach Hwy, Suite 110, Longview, WA 98632-4080 | 2016-02-17 |
| 1407220916 | Jackie Renee Kiser | Massage Therapist | 820 Ocean Beach Hwy, Ste 116, Longview, WA 98632-4080 | 2015-11-20 |
| 1346517570 | Riverwoods Chiropractic & Massage, Pllc | Chiropractor | 820 Ocean Beach Hwy, Suite 116, Longview, WA 98632-4080 | 2011-11-16 |
| 1093020778 | Jeromy R. Dixson, D.m.d., P.s. | Dentist | 820 Ocean Beach Hwy, Suite 110, Longview, WA 98632-4080 | 2010-08-18 |
| 1346574316 | Derrik Palmer Stark | Dentist | 820 Ocean Beach Hwy, Suite 110, Longview, WA 98632-4080 | 2009-09-23 |
| 1386878965 | Kristi Kaylynn Poe | Optometrist | 820 Ocean Beach Hwy, Suite 100, Longview, WA 98632-4080 | 2009-05-11 |
| 1700051760 | Jared Doman | Dentist | 820 Ocean Beach Hwy, Suite 110, Longview, WA 98632-4080 | 2008-04-29 |
| 1861535197 | Longview Eye & Vision | Optometrist | 820 Ocean Beach Hwy, Suite 100, Longview, WA 98632-4011 | 2007-02-15 |
| 1508925405 | Terence O Tack | Optometrist | 820 Ocean Beach Hwy, Suite 100, Longview, WA 98632-4011 | 2006-12-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851992366 | Honor Senior Care LLC | Home Health Aide | 1135 3rd Ave, Ste S101, Longview, WA 98632 | 2020-11-03 |
| 1417416728 | Sam Wise | Dentist | 1538 11th Ave Lowr Columbia, Longview, WA 98632 | 2019-03-16 |
| 1053870717 | Matthew Johnson | Physician Assistant | 900 Ocean Beach Hwy Ste 110, Longview, WA 98632 | 2019-03-12 |
| 1295205367 | Abid Valji | Occupational Therapist | Americana Health and Rehabilitation Center, 917 7th Ave, Longview, WA 98632 | 2018-11-30 |
| 1184106437 | Peacehealth | Durable Medical Equipment & Medical Supplies | Triangle Mall Suite 16 1015 Ocean Beach Hwy, Longview, WA 98632 | 2018-09-04 |
| 1982186318 | Linda Joan Mason | Licensed Practical Nurse | 1153 23rd Ave, Longview, WA 98632 | 2018-09-01 |
| 1891291910 | Ellen Sumner Hornbeak | Physical Therapist | 200 Triangle Shopping Ctr Ste 270, Longview, WA 98632 | 2018-04-05 |
| 1700399961 | Johnna Joyce Knapp | Speech-Language Pathologist | 2615 Lilac St, Longview, WA 98632 | 2017-11-09 |
| 1841711868 | Deborah Annette Burzynski | Registered Nurse | 1057 12th Avenue, Longview, WA 98632 | 2017-06-29 |
| 1598291122 | Cheyenne West | Counselor | 1616 10th Avenue, Longview, WA 98632 | 2017-05-02 |
| Find all providers in zip 98632 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629547971 | Alex Soliz | Optometrist | 2304 Judson Rd Ste B, Longview, TX 75605-4674 | 2018-11-15 |
| 1700252640 | Gregory K. Wacasey Od Pllc | Optometrist | 2834 Bill Owens Pkwy, Longview, TX 75605-2102 | 2015-08-14 |
| 1942619275 | Blake Thomas Williams | Optometrist | 2394 H G Mosley Pkwy, Longview, TX 75604-3661 | 2014-08-12 |
| 1083979728 | Steven Daniel Barraza | Optometrist | 3098 N Eastman Rd, Longview, TX 75605-5176 | 2012-07-09 |
| 1427211416 | Rachel Lynnet Burnett | Optometrist | 1506 Judson Rd, Longview, TX 75601-3919 | 2008-07-09 |
| 1073712485 | Kristofer Kyle Thornton | Optometrist | 2500 Judson Rd Ste B, Longview, TX 75605-4640 | 2007-07-16 |
| 1477750081 | August Michael Wallace | Optometrist | 3032 N Eastman Rd Ste 100, Longview, TX 75605-5024 | 2007-06-27 |
| 1649368200 | William V Cheslock | Optometrist | 950 11th Ave, Longview, WA 98632-2504 | 2006-10-10 |
| 1437254539 | James H Mcdowell | Optometrist | 311b N High St, Longview, TX 75601-6336 | 2006-09-13 |
| 1881705333 | Harry D Evans | Optometrist | 1208 Reel Rd, Ste C, Longview, TX 75604-2586 | 2006-08-31 |
| Find all providers in LONGVIEW | ||||
Please comment or provide details below to improve the information on JEFFREY S TACK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.