Provider Demographics
NPI:1609995844
Name:BROOKS, TRACY K (OD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:K
Last Name:BROOKS
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 1:388 HAWKINS AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:LAKE RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-4280
Mailing Address - Country:US
Mailing Address - Phone:631-588-7004
Mailing Address - Fax:631-588-2612
Practice Address - Street 1:388 HAWKINS AVE STE 2
Practice Address - Street 2:
Practice Address - City:LAKE RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-4280
Practice Address - Country:US
Practice Address - Phone:631-588-7004
Practice Address - Fax:631-588-2612
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT006148152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist