Provider Demographics
NPI:1184630360
Name:KLEIN, TRACY A (OD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:A
Last Name:KLEIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:TRACY
Other - Middle Name:ANN
Other - Last Name:HEIDENREICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2349 DEMING WAY
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-5530
Practice Address - Country:US
Practice Address - Phone:608-824-3937
Practice Address - Fax:608-833-3326
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2682-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2682OtherEYEMED VISION NO.
WI2682OtherEYEMED VISION NO.
WIU68164Medicare UPIN
WI38605300Medicaid