=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487236469
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRACY ELAINE HUTCHINGS OD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2021
-----------------------------------------------------
Last Update Date | 04/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3301 N MILLER RD STE 140
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85251-6457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-947-7651
-----------------------------------------------------
Fax | 602-508-4830
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4800 N 22ND ST STE 210
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85016-4963
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-892-8400
-----------------------------------------------------
Fax | 602-508-4830
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPT-002569
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------