Provider Demographics
NPI:1578530648
Name:PUENT, BRIAN DAMIEN (MS OD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:DAMIEN
Last Name:PUENT
Suffix:
Gender:M
Credentials:MS OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 RIB MOUNTAIN DR STE 120
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-7196
Mailing Address - Country:US
Mailing Address - Phone:715-803-2700
Mailing Address - Fax:833-263-1968
Practice Address - Street 1:2600 RIB MOUNTAIN DR STE 120
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401
Practice Address - Country:US
Practice Address - Phone:715-803-2700
Practice Address - Fax:833-263-1968
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2977152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist