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NPI Code Detail

MEDICARE: PATRICIA APRIL PUCKETT LDO

MEDICARE:   PATRICIA APRIL PUCKETT  LDO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1156FX1800XOptician1101002873VA

General Provider Information

NPI Number : 1508624347
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICIA APRIL PUCKETT LDO
Provider Business Mailing Address
First Line : 1800 CARL D SILVER PKWY
Second Line :
City : FREDERICKSBURG
State : VA
Zip : 22401-4960
Country : US
Telephone Number : 540-786-8180
Fax Number :
Provider Business Practice Location Address
First Line : 1800 CARL D SILVER PKWY
Second Line :
City : FREDERICKSBURG
State : VA
Zip : 22401-4960
Country : US
Telephone Number : 540-786-8180
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2024
Last Update Date : 03/07/2024

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Directions to “ PATRICIA APRIL PUCKETT LDO” Practice Location

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