Provider Demographics
NPI:1790215192
Name:TVC OD, LLC
Entity Type:Organization
Organization Name:TVC OD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-601-2953
Mailing Address - Street 1:800 MAIN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:TILLAMOOK
Mailing Address - State:OR
Mailing Address - Zip Code:97141-3760
Mailing Address - Country:US
Mailing Address - Phone:503-842-5568
Mailing Address - Fax:503-842-1122
Practice Address - Street 1:800 MAIN AVE STE A
Practice Address - Street 2:
Practice Address - City:TILLAMOOK
Practice Address - State:OR
Practice Address - Zip Code:97141-3760
Practice Address - Country:US
Practice Address - Phone:503-842-5568
Practice Address - Fax:503-842-1122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center