Provider Demographics
NPI:1376951418
Name:PUTNAM-SCZEPANSKI, TRACY (OD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:
Last Name:PUTNAM-SCZEPANSKI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:PUTNAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:2001 COOLIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-1378
Mailing Address - Country:US
Mailing Address - Phone:517-337-0316
Mailing Address - Fax:517-337-1779
Practice Address - Street 1:5100 MARSH RD STE H
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1195
Practice Address - Country:US
Practice Address - Phone:517-349-0150
Practice Address - Fax:517-349-0157
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005022152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4901005022OtherSTATE LICENSE