Individual
LIBBI TRACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1121 S GILBERT RD, SUITE 103, MESA, AZ 85204-5235
(480) 854-3310
(480) 854-1157
Mailing address
1626 E KENWOOD ST, MESA, AZ 85203-2151
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
767
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DB1051
RAILROAD MEDICARE GROUP ID
AZ
01
—
P00086938
RAILROAD MEDICARE PIN
AZ
Enumeration date
11/15/2006
Last updated
07/22/2016
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