Provider Demographics
NPI:1891961165
Name:TWIN CITY VISION PLLC
Entity Type:Organization
Organization Name:TWIN CITY VISION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARREL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:360-636-6111
Mailing Address - Street 1:4503 OCEAN BEACH HWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-5052
Mailing Address - Country:US
Mailing Address - Phone:360-636-6111
Mailing Address - Fax:360-636-4050
Practice Address - Street 1:4503 OCEAN BEACH HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-5052
Practice Address - Country:US
Practice Address - Phone:360-636-6111
Practice Address - Fax:360-636-4050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADO 00002099305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service