Tracey Weng, OD | |
4110 Mystic Valley Pkwy, Medford, MA 02155-6931 | |
(781) 350-7008 | |
Not Available |
Full Name | Tracey Weng |
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Gender | Female |
Speciality | Optometrist |
Location | 4110 Mystic Valley Pkwy, Medford, Massachusetts |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1720762305 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 5627 (Massachusetts) | Primary |
Provider Name | Lickteig Family Eyecare Pc |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1063720498 PECOS PAC ID: 6002096328 Enrollment ID: O20110203000603 |
Mailing Address | Practice Location Address |
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Tracey Weng, OD 15 Grape St, Malden, MA 02148-5710 Ph: () - | Tracey Weng, OD 4110 Mystic Valley Pkwy, Medford, MA 02155-6931 Ph: (781) 350-7008 |
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