| Tvc OD, LLC | |
|
2101 5th St Tillamook OR 97141-2330 | |
| (503) 842-5568 | |
| (503) 842-1122 |
| Full Name | Tvc OD, LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 2101 5th St, Tillamook, Oregon |
| Authorized Official Name and Position | Lee Johnson (MEMBER) |
| Authorized Official Contact | 3606012953 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tvc OD, LLC 2101 5th St Tillamook OR 97141-2330 Ph: (503) 842-5568 | Tvc OD, LLC 2101 5th St Tillamook OR 97141-2330 Ph: (503) 842-5568 |
| NPI Number | 1790215192 |
|---|---|
| Provider Enumeration Date | 06/18/2017 |
| Last Update Date | 12/11/2025 |
| Certification Date | 12/11/2025 |
| Medicare PECOS PAC ID | 1456619360 |
|---|---|
| Medicare Enrollment ID | O20171226001850 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790215192 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Primary |
| Provider Name | Lee M Johnson |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1104113497 PECOS PAC ID: 7214188655 Enrollment ID: I20170814002658 |
| Provider Name | Christopher Don Jenck |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1497470199 PECOS PAC ID: 1153797766 Enrollment ID: I20221024001574 |
| Provider Name | Shauntel Steele |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1851060420 PECOS PAC ID: 9537532304 Enrollment ID: I20230224001654 |
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