Provider Demographics
NPI:1760688675
Name:DEMONTIGNY, TRACY FREE (OD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:FREE
Last Name:DEMONTIGNY
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 1:596 COBB PKWY S
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-6517
Mailing Address - Country:US
Mailing Address - Phone:770-429-1847
Mailing Address - Fax:770-590-7103
Practice Address - Street 1:596 COBB PKWY SOUTH
Practice Address - Street 2:EYESITE OPTICAL
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060
Practice Address - Country:US
Practice Address - Phone:770-429-1847
Practice Address - Fax:770-590-7103
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1359-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist