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General NPI Number Information
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NPI Number | 1528023637
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Entity Type | Individual
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Provider Name | EMERSON RICHARDS TRACY OPTOMETRIC PHYSICIAN
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Gender | Male
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 11/13/2012
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Provider Practice Location Address
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Address Line | 3000 W BRIGANTINE AVENUE
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City | BRIGANTINE
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State | NJ
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Zip | 08203
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Country | US
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Telephone | 609-266-3553
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Fax | 609-266-4131
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Provider Business Mailing Address
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Address Line | 3000 W. BRIGANTINE AVE
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City | BRIGANTINE
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State | NJ
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Zip | 08203-1704
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Country | US
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Telephone | 609-266-3553
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Fax | 609-266-4131
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2704
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | #2704
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License Number State | NJ
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