Basic Information
| Provider Information | |||||||||
| NPI: | 1154353944 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARSHALL-UNDERWOOD | ||||||||
| FirstName: | TRACEY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 YARMOUTH WAY | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199045392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027345861 | ||||||||
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| Practice Location | |||||||||
| Address1: | 103 WOLF CREEK BLVD | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | DOVER | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199014915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026783932 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 12/26/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | I3-0001312 | DE | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.