Provider Demographics
NPI:1801891403
Name:BOSS, TRACEY C (OD)
Entity type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:C
Last Name:BOSS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:31519 WINTERPLACE PKWY
Mailing Address - Street 2:STE 1
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-1884
Mailing Address - Country:US
Mailing Address - Phone:410-546-2500
Mailing Address - Fax:410-546-5005
Practice Address - Street 1:31519 WINTERPLACE PKWY
Practice Address - Street 2:STE 1
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1884
Practice Address - Country:US
Practice Address - Phone:410-546-2500
Practice Address - Fax:410-546-5005
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0006064UVT152W00000X, 152WP0200X
DE13-0001320152W00000X
MDTA2027152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD012728100Medicaid
MDP00412417Medicare PIN
U68729Medicare UPIN
DE003184A90Medicare PIN
MD174LP765Medicare PIN