Provider Demographics
NPI:1669826426
Name:TRACEY A SCHMUCKER MD PA
Entity Type:Organization
Organization Name:TRACEY A SCHMUCKER MD PA
Other - Org Name:LOWERY EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHMUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-268-7154
Mailing Address - Street 1:105 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-7329
Mailing Address - Country:US
Mailing Address - Phone:501-268-7154
Mailing Address - Fax:501-268-9071
Practice Address - Street 1:105 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-7329
Practice Address - Country:US
Practice Address - Phone:501-268-7154
Practice Address - Fax:501-268-9071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3864207W00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR7578250001Medicare PIN
ARH97297Medicare UPIN