Provider Demographics
NPI:1598107948
Name:GOODWIN, TRACY LYNN
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 YMCA DR
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-5124
Mailing Address - Country:US
Mailing Address - Phone:972-937-1831
Mailing Address - Fax:972-937-1835
Practice Address - Street 1:101 YMCA DR
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-5124
Practice Address - Country:US
Practice Address - Phone:972-937-1831
Practice Address - Fax:972-937-1835
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician