Provider Demographics
NPI:1215367917
Name:KINGSOLVER, TRACIE (OD)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:
Last Name:KINGSOLVER
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 1:2920 GLENDALE MILFORD RD STE 220
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-3131
Mailing Address - Country:US
Mailing Address - Phone:513-557-3669
Mailing Address - Fax:
Practice Address - Street 1:5303 GLENWAY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-3706
Practice Address - Country:US
Practice Address - Phone:513-922-9000
Practice Address - Fax:513-922-4050
Is Sole Proprietor?:No
Enumeration Date:2013-11-15
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6248152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6248OtherOHIO