Provider Demographics
NPI:1649591785
Name:PUTMAN, SYLVIA ANN (ABOC)
Entity Type:Individual
Prefix:MRS
First Name:SYLVIA
Middle Name:ANN
Last Name:PUTMAN
Suffix:
Gender:F
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 24TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1830
Mailing Address - Country:US
Mailing Address - Phone:806-793-6000
Mailing Address - Fax:806-793-6100
Practice Address - Street 1:3801 24TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1830
Practice Address - Country:US
Practice Address - Phone:806-793-6000
Practice Address - Fax:806-793-6100
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX162035156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician