Provider Demographics
NPI:1912000803
Name:GEORGE, TRACEY ANNE (OD)
Entity Type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:ANNE
Last Name:GEORGE
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 1:1216 ELLSWORTH DRIVE
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052
Mailing Address - Country:US
Mailing Address - Phone:610-266-8933
Mailing Address - Fax:610-264-8076
Practice Address - Street 1:2601 MACARTHUR RD
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-3818
Practice Address - Country:US
Practice Address - Phone:610-266-8933
Practice Address - Fax:610-264-8076
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG 000777152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU57848Medicare UPIN