Provider Demographics
NPI:1437261500
Name:PUNTNEY, PAUL EDWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:EDWARD
Last Name:PUNTNEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 W WACO DR STE 106
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-6301
Mailing Address - Country:US
Mailing Address - Phone:254-399-9388
Mailing Address - Fax:254-399-9312
Practice Address - Street 1:6001 W WACO DR STE 106
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-6301
Practice Address - Country:US
Practice Address - Phone:254-399-9388
Practice Address - Fax:254-399-9312
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2107T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149990701Medicaid
TX149990701Medicaid
TXT-15391Medicare UPIN