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General NPI Number Information
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NPI Number | 1710870183
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Entity Type | Individual
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Provider Name | JESSE ERIN PUCKETT OD
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Gender | Female
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 2801 FREDERICK RD
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City | OPELIKA
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State | AL
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Zip | 36801-7101
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Country | US
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Telephone | 334-679-1183
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Fax |
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Provider Business Mailing Address
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Address Line | 303 NORTHGATE BLVD
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City | AUBURN
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State | AL
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Zip | 36830-4431
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Country | US
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Telephone |
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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 | S-F61-TA-D76
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License Number State | AL
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