MEDICARE: DR. JULIE A TRACEY O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	18003551	IN
2	152W00000X	Optometrist	4901004512	MI

General Provider Information

NPI Number	:	1619126364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIE A TRACEY O.D.

Provider Business Mailing Address
First Line	:	735 JOHN R RD STE 150
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48083-5859
Country	:	US
Telephone Number	:	248-588-9300
Fax Number	:	248-588-9917

Provider Business Practice Location Address
First Line	:	18756 MIDDLEBELT RD
Second Line	:
City	:	LIVONIA
State	:	MI
Zip	:	48152-3528
Country	:	US
Telephone Number	:	248-476-5350
Fax Number	:	248-476-5355

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2008
Last Update Date	:	01/13/2020

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