MEDICARE: ALYSSA A PUTMAN OPTOMETRIST PC

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

General Provider Information

NPI Number	:	1710730635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALYSSA A PUTMAN OPTOMETRIST PC

Provider Business Mailing Address
First Line	:	17 MEADOW LN
Second Line	:
City	:	PAINTED POST
State	:	NY
Zip	:	14870-9318
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	382 W CHURCH ST
Second Line	:
City	:	ELMIRA
State	:	NY
Zip	:	14901-2621
Country	:	US
Telephone Number	:	607-733-2694
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. ALYSSA A PUTMAN
Credential	:	OD
Telephone Number	:	607-368-0529

Provider Enumeration Date	:	04/10/2024
Last Update Date	:	05/16/2024

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