Provider Demographics
NPI:1740947001
Name:TRACY, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:TRACY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1713 HIGHWAY 121 BYP N STE B
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-8853
Mailing Address - Country:US
Mailing Address - Phone:270-216-2020
Mailing Address - Fax:270-216-2726
Practice Address - Street 1:1713 HIGHWAY 121 BYP N STE B
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-8853
Practice Address - Country:US
Practice Address - Phone:270-216-2020
Practice Address - Fax:270-216-2726
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2259DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist