Provider Demographics
NPI:1255600763
Name:ALL FAMILY VISION LLC
Entity type:Organization
Organization Name:ALL FAMILY VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEINTZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-757-8844
Mailing Address - Street 1:1597 SW 53RD ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-2630
Mailing Address - Country:US
Mailing Address - Phone:541-757-8844
Mailing Address - Fax:
Practice Address - Street 1:1597 SW 53RD ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-2630
Practice Address - Country:US
Practice Address - Phone:541-757-8844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3307ATI152W00000X
332H00000X
OR2515T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR163171OtherMEDICARE PTAN
ORR163394OtherMEDICARE PTAN
ORR163170Medicare PIN