Provider Demographics
NPI:1710358049
Name:PUENT OPTOMETRY LLC
Entity Type:Organization
Organization Name:PUENT OPTOMETRY LLC
Other - Org Name:RIB MOUNTAIN EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:DAMIEN
Authorized Official - Last Name:PUENT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:715-574-6672
Mailing Address - Street 1:2600 RIB MOUNTAIN DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-7196
Mailing Address - Country:US
Mailing Address - Phone:715-574-6672
Mailing Address - Fax:
Practice Address - Street 1:2600 RIB MOUNTAIN DR
Practice Address - Street 2:SUITE 120
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-7196
Practice Address - Country:US
Practice Address - Phone:715-574-6672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2977152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty