MEDICARE: DR. TRACY J COWAN 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	OPC-4311	FL
2	152W00000X	Optometrist	046008730	IL

General Provider Information

NPI Number	:	1902094808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACY J COWAN O.D.

Provider Business Mailing Address
First Line	:	698 NELSON CT
Second Line	:
City	:	GENEVA
State	:	IL
Zip	:	60134-4686
Country	:	US
Telephone Number	:	239-443-8144
Fax Number	:

Provider Business Practice Location Address
First Line	:	6800 W US HIGHWAY 34
Second Line	:
City	:	PLANO
State	:	IL
Zip	:	60545-9607
Country	:	US
Telephone Number	:	630-552-1593
Fax Number	:

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

Provider Enumeration Date	:	10/05/2007
Last Update Date	:	08/20/2020

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