Provider Demographics
NPI:1710169669
Name:PUN, ROSANNA M (OD)
Entity Type:Individual
Prefix:
First Name:ROSANNA
Middle Name:M
Last Name:PUN
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 1:9889 BELLAIRE BLVD STE 313
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-3468
Mailing Address - Country:US
Mailing Address - Phone:713-271-6898
Mailing Address - Fax:
Practice Address - Street 1:9889 BELLAIRE BLVD STE 313
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-3468
Practice Address - Country:US
Practice Address - Phone:713-271-6898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2012-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5787152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00Y402OtherMEDICARE PTAN
TX149833901Medicaid
TX8AJ003OtherBLUE CROSS BLUE SHIELD
00Y402OtherMEDICARE PTAN