Healthcare Provider Details

I. General information

NPI: 1487236469
Provider Name (Legal Business Name): TRACY ELAINE HUTCHINGS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 N MILLER RD STE 140
SCOTTSDALE AZ
85251-6457
US

IV. Provider business mailing address

4800 N 22ND ST STE 210
PHOENIX AZ
85016-4963
US

V. Phone/Fax

Practice location:
  • Phone: 480-947-7651
  • Fax: 602-508-4830
Mailing address:
  • Phone: 480-892-8400
  • Fax: 602-508-4830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-002569
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: