MEDICARE: DR W.B. PUTTERMAN, P.C.

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
1	152W00000X	Optometrist	OEG000083	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649429663
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR W.B. PUTTERMAN, P.C.

Provider Business Mailing Address
First Line	:	6155 RIDGE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-2627
Country	:	US
Telephone Number	:	215-483-3400
Fax Number	:	215-483-7401

Provider Business Practice Location Address
First Line	:	6155 RIDGE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-2627
Country	:	US
Telephone Number	:	215-483-3400
Fax Number	:	215-483-7401

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WILLIAM B PUTTERMAN
Credential	:	O.D.
Telephone Number	:	215-483-3400

Provider Enumeration Date	:	09/15/2008
Last Update Date	:	12/08/2011

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