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Individual
DR. TRACEY L. YOTHERS
Active
Individual
DR. TRACEY L. YOTHERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
05168TG
TX
152WC0802X
Corneal and Contact Management Optometrist
05168TG
TX
152WP0200X
Pediatric Optometrist
05168TG
TX
152WV0400X
Vision Therapy Optometrist
05168TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00E52G
GROUP BCBS NUMBER
TX
01
—
021948
BLOCK MEDICAID LOCAT #
TX
05
—
040972404
—
TX
05
—
176941601
—
TX
01
—
921409
INDIVIDUAL BLOCK MEDICAID
TX
01
—
T13054
INDIVIDUAL BCBS
TX
Enumeration date
12/17/2006
Last updated
07/08/2010
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