Basic Information
| Provider Information | |||||||||
| NPI: | 1598150336 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRACY EYE CARE MEDICAL CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 303 W EATON AVE | ||||||||
| Address2: | |||||||||
| City: | TRACY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953763418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2098361155 | ||||||||
| FaxNumber: | 2098360478 | ||||||||
| Practice Location | |||||||||
| Address1: | 303 W EATON AVE | ||||||||
| Address2: | |||||||||
| City: | TRACY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953763418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2098361155 | ||||||||
| FaxNumber: | 2098360478 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2015 | ||||||||
| LastUpdateDate: | 03/30/2015 | ||||||||
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| AuthorizedOfficialLastName: | O'NEIL | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT OF CORPORATION | ||||||||
| AuthorizedOfficialTelephone: | 2098361155 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | THOMAS C O'NEIL MD | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | A34142 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.