Provider Demographics
NPI:1598150336
Name:TRACY EYE CARE MEDICAL CLINIC
Entity Type:Organization
Organization Name:TRACY EYE CARE MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:O'NEIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-836-1155
Mailing Address - Street 1:303 W EATON AVE
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3418
Mailing Address - Country:US
Mailing Address - Phone:209-836-1155
Mailing Address - Fax:209-836-0478
Practice Address - Street 1:303 W EATON AVE
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3418
Practice Address - Country:US
Practice Address - Phone:209-836-1155
Practice Address - Fax:209-836-0478
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THOMAS C O'NEIL MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34142207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA27389Medicare UPIN
CAFA502AMedicare PIN