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NPI Code Detail

MEDICARE: DR. PUNAM S SIRASKY OD

MEDICARE: DR. PUNAM S SIRASKY OD
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
1152W00000XOptometrist1166AZ
2152W00000XOptometrist1912DTKY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11588877989OTHERNPI

General Provider Information

NPI Number : 1588877989
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PUNAM S SIRASKY OD
Provider Business Mailing Address
First Line : 2819 DIXIE HWY
Second Line : NEXT TO LENSCRAFTERS
City : CRESTVIEW HILLS
State : KY
Zip : 41017
Country : US
Telephone Number : 589-331-3124
Fax Number : 859-331-4895
Provider Business Practice Location Address
First Line : 2819 DIXIE HWY
Second Line : NEXT TO LENSCRAFTERS
City : CRESTVIEW HILLS
State : KY
Zip : 41017
Country : US
Telephone Number : 859-331-3124
Fax Number : 859-331-4895
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2007
Last Update Date : 07/21/2022

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Directions to “ DR. PUNAM S SIRASKY OD” Practice Location

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