Provider Demographics
NPI:1336248954
Name:PAUL, TRACI LYNNE (OD)
Entity Type:Individual
Prefix:DR
First Name:TRACI
Middle Name:LYNNE
Last Name:PAUL
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 1:30030 TOWN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2096
Mailing Address - Country:US
Mailing Address - Phone:949-495-3031
Mailing Address - Fax:
Practice Address - Street 1:30030 TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2096
Practice Address - Country:US
Practice Address - Phone:949-495-3031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9695T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist