Provider Demographics
NPI:1154353944
Name:MARSHALL-UNDERWOOD, TRACEY (OD)
Entity type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:
Last Name:MARSHALL-UNDERWOOD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 YARMOUTH WAY
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-5392
Mailing Address - Country:US
Mailing Address - Phone:302-734-5861
Mailing Address - Fax:
Practice Address - Street 1:103 WOLF CREEK BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4915
Practice Address - Country:US
Practice Address - Phone:302-678-3932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEI3-0001312152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist