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General NPI Number Information
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NPI Number | 1679630719
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Entity Type | Individual
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Provider Name | J ALLEN PUMA O.D.
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Gender | Male
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Dates
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Enumeration Date | 01/01/2007
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Last Update Date | 03/04/2008
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Provider Practice Location Address
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Address Line | 30 MAIN ST SUITE 120
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City | BURLINGTON
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State | VT
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Zip | 05401-8438
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Country | US
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Telephone | 802-658-7610
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Fax |
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Provider Business Mailing Address
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Address Line | 469 RIDGEFIELD RD
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City | SHELBURNE
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State | VT
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Zip | 05482-6319
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Country | US
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Telephone | 802-985-3506
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0300000240
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License Number State | VT
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