Provider Demographics
NPI:1831249374
Name:MERCER, TRACEY L (OD)
Entity type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:L
Last Name:MERCER
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 1:2000 SOUTHLAKE PARK
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-3616
Mailing Address - Country:US
Mailing Address - Phone:205-968-1160
Mailing Address - Fax:205-968-1159
Practice Address - Street 1:2000 SOUTHLAKE PARK
Practice Address - Street 2:SUITE 100
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-3616
Practice Address - Country:US
Practice Address - Phone:205-968-1160
Practice Address - Fax:205-968-1159
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS938TA511152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU79010Medicare UPIN
AL051504336Medicare ID - Type Unspecified