Provider Demographics
NPI:1902095581
Name:PATTON, TRACY WINTON (OD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:WINTON
Last Name:PATTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524B DONELSON PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3729
Mailing Address - Country:US
Mailing Address - Phone:615-889-0147
Mailing Address - Fax:615-889-2700
Practice Address - Street 1:524B DONELSON PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-3729
Practice Address - Country:US
Practice Address - Phone:615-889-0147
Practice Address - Fax:615-889-2700
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN2762152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I415824Medicare PIN