Provider Demographics
NPI:1972621886
Name:DODD, TRACY ELIZABETH (OD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:ELIZABETH
Last Name:DODD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:TETRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:6680 NE 159TH AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-3880
Mailing Address - Country:US
Mailing Address - Phone:360-449-3937
Mailing Address - Fax:
Practice Address - Street 1:6680 NE 159TH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-3880
Practice Address - Country:US
Practice Address - Phone:360-449-3937
Practice Address - Fax:360-449-3094
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3359TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist