Provider Demographics
NPI:1215212493
Name:HO, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:HO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 JACKIE RD SE
Mailing Address - Street 2:7403
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-6610
Mailing Address - Country:US
Mailing Address - Phone:505-892-8411
Mailing Address - Fax:505-891-5497
Practice Address - Street 1:4025 JACKIE RD SE
Practice Address - Street 2:7403
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-6610
Practice Address - Country:US
Practice Address - Phone:505-892-8411
Practice Address - Fax:505-891-5497
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM674152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist