Provider Demographics
NPI:1447601729
Name:ROSSI, TRACY (OD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:ROSSI
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 1:257 STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-5315
Mailing Address - Country:US
Mailing Address - Phone:516-776-7618
Mailing Address - Fax:
Practice Address - Street 1:624 HAWKINS AVE STE 1
Practice Address - Street 2:
Practice Address - City:LAKE RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-2375
Practice Address - Country:US
Practice Address - Phone:631-588-5100
Practice Address - Fax:631-588-5185
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008475152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist