MEDICARE: DR. AMY ARLENE PUERTO O.D.

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	1993DT	KY

General Provider Information

NPI Number	:	1881070498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY ARLENE PUERTO O.D.

Provider Business Mailing Address
First Line	:	222 VETERANS BLVD
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-4724
Country	:	US
Telephone Number	:	225-791-2020
Fax Number	:	225-791-2077

Provider Business Practice Location Address
First Line	:	222 VETERANS BLVD
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-4724
Country	:	US
Telephone Number	:	225-791-2020
Fax Number	:	225-791-2077

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

Provider Enumeration Date	:	08/05/2015
Last Update Date	:	08/05/2015

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