Provider Demographics
NPI:1407108624
Name:PUTMAN, ALYSSA A (OD)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:A
Last Name:PUTMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 TEST RD
Mailing Address - Street 2:APT 3
Mailing Address - City:NEWFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14867
Mailing Address - Country:US
Mailing Address - Phone:607-368-0529
Mailing Address - Fax:
Practice Address - Street 1:40 CATHERWOOD RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1056
Practice Address - Country:US
Practice Address - Phone:607-257-2333
Practice Address - Fax:607-257-1763
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8087T152W00000X
NYTUV008069152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist