Organization
PAUL TRACY OD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL D TRACY OD (OWNER)
(573) 406-1503
Entity
Organization
Contact information
Practice address
3650 STARDUST DR, HANNIBAL, MO 63401-2480
(573) 406-1503
(573) 406-1057
Mailing address
2316 BRIAR LN, QUINCY, IL 62305-6574
(816) 645-8025
(573) 406-1057
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2001020432
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39941018
BLUECROSS BLUE SHIELD
MO
Enumeration date
04/23/2008
Last updated
12/18/2012
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