Provider Demographics
NPI:1134205701
Name:JONES, TRACIE LORRAINE (OD)
Entity type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:LORRAINE
Last Name:JONES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:TRACIE
Other - Middle Name:LORRAINE
Other - Last Name:GILMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1839 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-1150
Mailing Address - Country:US
Mailing Address - Phone:814-868-5455
Mailing Address - Fax:814-868-5467
Practice Address - Street 1:1839 W 26TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-1150
Practice Address - Country:US
Practice Address - Phone:814-868-5455
Practice Address - Fax:814-868-5467
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE007725T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA224005OtherEYEMED
PA411116OtherUPMC
PA7725OtherVBA
PA000676768OtherBLUE CROSS/BLUE SHIELD
PA436202OtherHEALTH AMERICA/HEALTH ASS
PA7725OtherVBA
000676768Medicare ID - Type Unspecified