MEDICARE: TRACY C CRNIC M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	2025036618	MO
2	207W00000X	Ophthalmology Physician	L5710	TX
3	207W00000X	Ophthalmology Physician	ME131719	FL
4	207WX0110X	Pediatric Ophthalmology and Strabismus Specialist Physician Physician	L5710	TX
5	207WX0110X	Pediatric Ophthalmology and Strabismus Specialist Physician Physician	2025036618	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255309514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY C CRNIC M.D.

Provider Business Mailing Address
First Line	:	PO BOX 843966
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64184-3966
Country	:	US
Telephone Number	:	573-884-3300
Fax Number	:	573-884-0943

Provider Business Practice Location Address
First Line	:	3215 WINGATE CT STE 102
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65201-7689
Country	:	US
Telephone Number	:	573-884-3937
Fax Number	:	573-884-4868

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	09/02/2025

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Directions to “ TRACY C CRNIC M.D.” Practice Location

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