NPIMap

Individual provider Active NPI

Tracy Lynn Moran, OD

  • Optometrist
  • Oxford, MI
National Provider Identifier
1568485746
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4901004320 Issued in MI
Practice address
89 S Washington St
Oxford, MI 48371-4979
Phone
(248) 628-3441
Fax
(248) 628-5105
NPI assigned
Jul 26, 2006
Last updated
Mar 17, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4901004320 MI Primary

Addresses

Primary practice location

89 S Washington St
Oxford, MI 48371-4979

Mailing address

89 S Washington St
Oxford, MI 48371-4979
Phone (248) 628-3441

Other practice location 1

837 S Lapeer Rd
Suite 101
Oxford, MI 48371-5084
Phone (248) 628-3441

Other identifiers 2

IdentifierTypeStateIssuer
4873840MedicaidMI
4856062OtherMIMEDICAID

Other names 1

  • Ms. Tracy Lynn Mills Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Clarity Oxford, PLLC Optometrist PastSince Nov 3, 2024 Accepting new patients
Luxottica Retail North America Inc Past Accepting new patients
House of Optical, Inc. Optometrist Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1568485746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "89 S WASHINGTON ST",
            "city": "OXFORD",
            "state": "MI",
            "postal_code": "483714979",
            "telephone_number": "248-628-3441",
            "fax_number": "248-628-5105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "89 S WASHINGTON ST",
            "city": "OXFORD",
            "state": "MI",
            "postal_code": "483714979",
            "telephone_number": "248-628-3441",
            "fax_number": "248-628-5105"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "837 S Lapeer Rd",
            "address_2": "Suite 101",
            "address_purpose": "LOCATION",
            "city": "Oxford",
            "state": "MI",
            "postal_code": "483715084",
            "country_code": "US",
            "telephone_number": "248-628-3441",
            "fax_number": "248-628-5105",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MORAN",
        "first_name": "TRACY",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-26",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004320",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4873840",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "4856062",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACY",
            "last_name": "MILLS",
            "middle_name": "LYNN",
            "prefix": "MS.",
            "credential": "OD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Oxford, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.