Healthcare Provider Details

I. General information

NPI: 1578502944
Provider Name (Legal Business Name): TRACY SCHEIBE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 ENTERPRISE DR
LYNCHBURG VA
24502-5751
US

IV. Provider business mailing address

PO BOX 1290
FOREST VA
24551-1290
US

V. Phone/Fax

Practice location:
  • Phone: 434-385-5600
  • Fax: 434-455-7172
Mailing address:
  • Phone: 434-385-5600
  • Fax: 434-455-7172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618000916
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: