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NPI Code Detail

MEDICARE: TRACY ROSSI O.D.

MEDICARE: TRACY ROSSI O.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
1152W00000XOptometrist008475NY

General Provider Information

NPI Number : 1447601729
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY ROSSI O.D.
Provider Business Mailing Address
First Line : 257 STEWART AVE
Second Line :
City : BETHPAGE
State : NY
Zip : 11714-5315
Country : US
Telephone Number : 516-776-7618
Fax Number :
Provider Business Practice Location Address
First Line : 624 HAWKINS AVE STE 1
Second Line :
City : LAKE RONKONKOMA
State : NY
Zip : 11779-2375
Country : US
Telephone Number : 631-588-5100
Fax Number : 631-588-5185
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2016
Last Update Date : 07/21/2022

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