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General NPI Number Information
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NPI Number | 1003237306
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Entity Type | Organization
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Legal Business Name | GARY TRACY, OD P.C.
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Dates
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Enumeration Date | 01/04/2014
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Last Update Date | 01/04/2014
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Provider Practice Location Address
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Address Line | 210 W 79TH ST
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City | NEW YORK
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State | NY
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Zip | 10024-6228
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Country | US
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Telephone | 212-877-5840
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Fax | 212-877-5841
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Provider Business Mailing Address
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Address Line | 210 W 79TH ST
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City | NEW YORK
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State | NY
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Zip | 10024-6228
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JULIE TRACY
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Credential |
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Telephone | 201-247-5893
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV003044-1
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License Number State | NY
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