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General NPI Number Information
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NPI Number | 1952675134
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Entity Type | Organization
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Legal Business Name | MICHAEL K. TRACY, M.D., PC
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Dates
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Enumeration Date | 03/06/2012
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Last Update Date | 09/25/2018
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Provider Practice Location Address
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Address Line | 6183 PASEO DEL NORTE STE 290
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City | CARLSBAD
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State | CA
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Zip | 92011-1151
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Country | US
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Telephone | 760-603-9910
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Fax | 760-603-9369
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Provider Business Mailing Address
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Address Line | 6183 PASEO DEL NORTE STE 290
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City | CARLSBAD
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State | CA
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Zip | 92011-1151
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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 | PRESIDENT & CEO
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Name | MICHAEL K TRACY
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Credential | M.D.
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Telephone | 760-603-9910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | C54009
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License Number State | CA
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