Provider Demographics
NPI:1023011228
Name:HARADON, TRACY A (O D)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:A
Last Name:HARADON
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 SUMNER AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01108-2320
Mailing Address - Country:US
Mailing Address - Phone:413-733-5155
Mailing Address - Fax:413-733-5119
Practice Address - Street 1:453 SUMNER AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01108-2320
Practice Address - Country:US
Practice Address - Phone:413-733-5155
Practice Address - Fax:413-733-5119
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3810152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA970751OtherNETWORK HEALTH
MD2748922OtherCIGNA
MA50449OtherCHILDRENS MEDICAL SECURIT
MA5310173OtherAETNA
MA000000027519OtherBOSTON MEDICAL CENTER HEA
MA2215920OtherFIRST HEALTH
MA22-00401OtherEVERCARE SENIOR OPTIONS
MA19101OtherHEALTH NEW ENGLAND
MA410106OtherTUFTS HEALTH PLANS
MAAA11181OtherHARVARD PILGRIM
MA0030314OtherNEIGHBORHOOD HEALTH PLAN
MAW15973OtherBLUE CROSS BLUE SHIELD
MA0392251Medicaid
MA2301488OtherUNITED HEALTHCARE
MA970751OtherNETWORK HEALTH
MA50449OtherCHILDRENS MEDICAL SECURIT