Provider Demographics
NPI:1659341600
Name:SHEEDY, TRACY SHERMAN (OD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:SHERMAN
Last Name:SHEEDY
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 1:7381 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:RED HOOK
Mailing Address - State:NY
Mailing Address - Zip Code:12571-1745
Mailing Address - Country:US
Mailing Address - Phone:845-758-8818
Mailing Address - Fax:845-758-9215
Practice Address - Street 1:7381 S BROADWAY
Practice Address - Street 2:
Practice Address - City:RED HOOK
Practice Address - State:NY
Practice Address - Zip Code:12571-1745
Practice Address - Country:US
Practice Address - Phone:845-758-8818
Practice Address - Fax:845-758-9215
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT005760152WL0500X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC211C1OtherBC/BS
NMVUT005760OtherLICENSE NUMBER
NY903535OtherBLOCK
NY903534OtherBLOCK
NY10032271OtherCDPHP
NY597054OtherMVP
NY0244570001Medicare NSC
NY10032271OtherCDPHP
NY597054OtherMVP