Healthcare Provider Details

I. General information

NPI: 1497829600
Provider Name (Legal Business Name): TODD DAVID PUNIM O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 LAKES RD
MONROE NY
10950-2613
US

IV. Provider business mailing address

9 CARRIAGE HILL CT
MONROE NY
10950-4477
US

V. Phone/Fax

Practice location:
  • Phone: 845-783-1224
  • Fax: 845-783-3905
Mailing address:
  • Phone: 845-238-3604
  • Fax: 845-783-3905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number5073
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: