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 1:603 QUAIL CREEK DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124
Mailing Address - Country:US
Mailing Address - Phone:806-331-2020
Mailing Address - Fax:806-331-2023
Practice Address - Street 1:8740 N KENDALL DR STE 117
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2209
Practice Address - Country:US
Practice Address - Phone:305-709-2211
Practice Address - Fax:786-631-5960
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5710207W00000X, 207WX0110X
FLME131719207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159256006Medicaid
FL110782600Medicaid
TXTXB102380Medicare PIN