Individual
DR. TRACY K GILES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1039 WASHINGTON AVE, PORTLAND, ME 04103-3628
(207) 775-6533
(207) 775-2702
Mailing address
1039 WASHINGTON AVE, PORTLAND, ME 04103-3628
(207) 775-6533
(207) 775-2702
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT707
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005291253
AETNA
ME
01
—
010531263
TAX ID#
ME
01
—
038328
ANTHEM BC/BS
ME
05
—
115510000
—
ME
01
—
2354892
AETNA HEALTH MANAGEMENT
ME
01
—
620118001
CIGNA HEALTHCARE
ME
Enumeration date
05/22/2006
Last updated
05/29/2019
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