Provider Demographics
NPI:1144214453
Name:SCHROECK, TRACY M (OD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:M
Last Name:SCHROECK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3424 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2740
Mailing Address - Country:US
Mailing Address - Phone:814-864-3039
Mailing Address - Fax:814-864-3030
Practice Address - Street 1:3424 PEACH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2740
Practice Address - Country:US
Practice Address - Phone:814-864-3039
Practice Address - Fax:814-864-3030
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000078152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU63093Medicare UPIN
PASC887580Medicare ID - Type Unspecified