Healthcare Provider Details

I. General information

NPI: 1811884711
Provider Name (Legal Business Name): AMANDA PUTOREK OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 OAKVALE RD STE 100
PRINCETON WV
24740-3829
US

IV. Provider business mailing address

324 OAKVALE RD STE 100
PRINCETON WV
24740-3829
US

V. Phone/Fax

Practice location:
  • Phone: 304-425-2444
  • Fax: 304-425-2446
Mailing address:
  • Phone: 304-425-2444
  • Fax: 304-425-2446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3056-IOD
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: