Provider Demographics
NPI:1093066482
Name:BRIAN D TRACY OD
Entity Type:Organization
Organization Name:BRIAN D TRACY OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:TRACY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:916-454-5729
Mailing Address - Street 1:3000 L ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5248
Mailing Address - Country:US
Mailing Address - Phone:916-454-5729
Mailing Address - Fax:916-454-5784
Practice Address - Street 1:3000 L ST STE 100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5248
Practice Address - Country:US
Practice Address - Phone:916-454-5729
Practice Address - Fax:916-454-5784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty