Emerson Richards Tracy, OPTOMETRIC PHYSICIAN
Individual provider Active NPI Optometrist · Brigantine, NJ
NPI 1528023637 · NPPES record last updated Nov 13, 2012
Key facts
- NPI
- 1528023637
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- #2704 (NJ)
- Practice address
- 3000 W Brigantine Avenue
Brigantine, NJ 08203 - Phone
- (609) 266-3553
- Fax
- (609) 266-4131
- NPI assigned
- Apr 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2704 | NJ | MD | Clinical Psychologist |
| #2704 | NJ | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2704 | NJ | |
| Optometrist | 152W00000X | #2704 | NJ | Yes |
Addresses
Primary practice location
3000 W Brigantine Avenue
Brigantine, NJ 08203
Mailing address
3000 W. Brigantine Ave
Brigantine, NJ 08203-1704
Phone (609) 266-3553
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1273205 | Medicaid | NJ |
Other providers in Brigantine, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 13, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.