Healthcare Provider Details

I. General information

NPI: 1669826426
Provider Name (Legal Business Name): TRACEY A SCHMUCKER MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 CENTRAL AVE
SEARCY AR
72143-7329
US

IV. Provider business mailing address

105 CENTRAL AVE
SEARCY AR
72143-7329
US

V. Phone/Fax

Practice location:
  • Phone: 501-268-7154
  • Fax: 501-268-9071
Mailing address:
  • Phone: 501-268-7154
  • Fax: 501-268-9071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberE3864
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. TRACEY A SCHMUCKER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 501-268-7154