Provider Demographics
NPI:1881933711
Name:KRICK, TRACY WANG (MD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:WANG
Last Name:KRICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YU
Other - Middle Name:TUNG
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2080 WOODWINDS DR STE 110
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2537
Mailing Address - Country:US
Mailing Address - Phone:651-714-6901
Mailing Address - Fax:
Practice Address - Street 1:2080 WOODWINDS DR STE 110
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2537
Practice Address - Country:US
Practice Address - Phone:651-714-6901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-13
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN68889207WX0120X
MDP32586207W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program