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General NPI Number Information
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NPI Number | 1144031964
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Entity Type | Individual
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Provider Name | TRACEY LYNN WIELAND
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Gender | Female
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Dates
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Enumeration Date | 01/20/2025
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 265 SEA ISLAND PKWY
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City | BEAUFORT
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State | SC
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Zip | 29907-1535
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Country | US
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Telephone | 843-489-3213
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Fax | 843-470-5087
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Provider Business Mailing Address
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Address Line | 265 SEA ISLAND PKWY
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City | BEAUFORT
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State | SC
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Zip | 29907-1535
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Country | US
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Telephone | 843-489-3213
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Fax | 843-470-5087
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 1455
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License Number State | SC
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