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General NPI Number Information
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NPI Number | 1922165067
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Entity Type | Organization
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Legal Business Name | J ALLEN PUMA OD PC
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Dates
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Enumeration Date | 01/01/2007
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Last Update Date | 08/22/2020
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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 | 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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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES ALLEN PUMA
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Credential | OD
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Telephone | 802-658-7610
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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 |
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License Number State |
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