Provider Demographics
NPI:1255309514
Name:CRNIC, TRACY C (MD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:C
Last Name:CRNIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:3215 WINGATE CT STE 102
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-7689
Practice Address - Country:US
Practice Address - Phone:573-884-3937
Practice Address - Fax:573-884-4868
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025036618207W00000X, 207WX0110X
TXL5710207W00000X, 207WX0110X
FLME131719207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159256006Medicaid
FL110782600Medicaid
TXTXB102380Medicare PIN