Healthcare Provider Details

I. General information

NPI: 1710870183
Provider Name (Legal Business Name): JESSE ERIN PUCKETT OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 FREDERICK RD
OPELIKA AL
36801-7101
US

IV. Provider business mailing address

303 NORTHGATE BLVD
AUBURN AL
36830-4431
US

V. Phone/Fax

Practice location:
  • Phone: 334-679-1183
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS-F61-TA-D76
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: