Provider Demographics
NPI:1619126364
Name:TRACEY, JULIE A (OD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:A
Last Name:TRACEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:MASTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:735 JOHN R RD STE 150
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5859
Mailing Address - Country:US
Mailing Address - Phone:248-588-9300
Mailing Address - Fax:248-588-9917
Practice Address - Street 1:18756 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3528
Practice Address - Country:US
Practice Address - Phone:248-476-5350
Practice Address - Fax:248-476-5355
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003551152W00000X
MI4901004512152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist