Individual
TRACY LYNN KOCEMBA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
15936 US HIGHWAY 63, HAYWARD, WI 54843-7162
(715) 634-1028
(715) 634-9733
Mailing address
15936 US HIGHWAY 63, HAYWARD, WI 54843-7162
(715) 634-1028
(715) 634-9733
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2684-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38600700
—
WI
01
—
874300004
MEDICARE AT INDIANHEAD
—
01
—
P00069305
PALMETTO RR MEDICARE
—
Enumeration date
11/15/2005
Last updated
02/23/2009
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