Provider Demographics
NPI:1871728006
Name:VALLONE, TRACIE ELLEN (OD)
Entity type:Individual
Prefix:DR
First Name:TRACIE
Middle Name:ELLEN
Last Name:VALLONE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1619 DEL PRADO BLVD S
Mailing Address - Street 2:VISION CENTER
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3713
Mailing Address - Country:US
Mailing Address - Phone:239-772-5115
Mailing Address - Fax:
Practice Address - Street 1:1619 DEL PRADO BLVD S
Practice Address - Street 2:VISION CENTER
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3713
Practice Address - Country:US
Practice Address - Phone:239-772-2663
Practice Address - Fax:239-772-1859
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3193152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist