Provider Demographics
NPI:1376660613
Name:HAIRSTON, TRACY KEITH (OD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:KEITH
Last Name:HAIRSTON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 WORCESTER RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701
Mailing Address - Country:US
Mailing Address - Phone:508-745-5088
Mailing Address - Fax:
Practice Address - Street 1:463 WORCESTER RD
Practice Address - Street 2:SUITE 300
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701
Practice Address - Country:US
Practice Address - Phone:508-745-5088
Practice Address - Fax:508-742-4146
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3711152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist