MEDICARE: MR. FRANK E PUCKETT 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	1007	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01292813	OTHER	CO	RAILROAD MEDICARE

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

General Provider Information

NPI Number	:	1881689198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FRANK E PUCKETT OD

Provider Business Mailing Address
First Line	:	1860 WOODMOOR DR
Second Line	:	STE 103
City	:	MONUMENT
State	:	CO
Zip	:	80132-9093
Country	:	US
Telephone Number	:	719-488-2042
Fax Number	:	719-488-0965

Provider Business Practice Location Address
First Line	:	1860 WOODMOOR DR
Second Line	:	STE 103
City	:	MONUMENT
State	:	CO
Zip	:	80132-9093
Country	:	US
Telephone Number	:	719-488-2042
Fax Number	:	719-488-0965

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	03/18/2016

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Directions to “ MR. FRANK E PUCKETT OD” Practice Location

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