MEDICARE: ROSANNA M. PUN 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
1	152W00000X	Optometrist	5787	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00Y402	OTHER		MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8AJ003	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1710169669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSANNA M. PUN OD

Provider Business Mailing Address
First Line	:	9889 BELLAIRE BLVD STE 313
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-3468
Country	:	US
Telephone Number	:	713-271-6898
Fax Number	:

Provider Business Practice Location Address
First Line	:	9889 BELLAIRE BLVD STE 313
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-3468
Country	:	US
Telephone Number	:	713-271-6898
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2007
Last Update Date	:	04/15/2012

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Directions to “ ROSANNA M. PUN OD” Practice Location

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