Paul Tracy OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2001020432 Issued in MO

Legal business name

PAUL TRACY OD

Practice address

3650 Stardust Dr
Hannibal, MO 63401-2480

Phone

(573) 406-1503

Fax

(573) 406-1057

NPI assigned

Apr 23, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Paul D Tracy, OD

Title

Owner

Phone

(573) 406-1503

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355788800000",
    "number": "1043485949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2316 BRIAR LN",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623056574",
            "telephone_number": "816-645-8025",
            "fax_number": "573-406-1057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3650 STARDUST DR",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634012480",
            "telephone_number": "573-406-1503",
            "fax_number": "573-406-1057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAUL TRACY OD",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-23",
        "last_updated": "2012-12-18",
        "status": "A",
        "authorized_official_last_name": "TRACY",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-406-1503",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2001020432",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUE SHIELD",
            "identifier": "39941018",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Pahlman
• Kevin Terrence Palka, MD
• Erica Parker, APN
• Navdeepa Parmar, MD
• Hemal M Patel, D.O.
• Allie Pennewell, DNP, CRNA
• Veronica Perkins, LCSW
• Kim M Peters, ANP
• Kathy Lynn Pfaffe, LPSW, LPC, LMSW
• Ryan A Pickett, PLPC

• Optometrist in Hannibal, MO
• Providers in Hannibal, MO by specialty
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.