Individual
MRS. TRACY LYNN MORAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
89 S WASHINGTON ST, OXFORD, MI 48371-4979
(248) 628-3441
(248) 628-5105
Mailing address
89 S WASHINGTON ST, OXFORD, MI 48371-4979
(248) 628-3441
(248) 628-5105
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901004320
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4856062
MEDICAID
MI
05
—
4873840
—
MI
Enumeration date
07/26/2006
Last updated
03/17/2018
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