Provider Demographics
NPI:1235314600
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
Mailing Address - Street 2:STE 100
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:
Practice Address - Street 1:3000 L ST
Practice Address - Street 2:STE 100
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9109T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA206384OtherCOLE VISION
CA211188OtherEYEMED
CA0536300001OtherDMERC CIGNA
CA34392OtherDAVIS VISION
CA02338OtherMEDICAL EYE SERVICES
CA410012517OtherRAILROAD MEDICARE
CA45457OtherSPECTERA VISION
CAGSD004430Medicaid
CA46598OtherSAFEGUARD VISION HMO
CA49282OtherSAFEGUARD VISION PPO
CA49282OtherSAFEGUARD VISION PPO