Provider Demographics
NPI:1821473422
Name:PUZZO, ALFONSO (OD)
Entity Type:Individual
Prefix:DR
First Name:ALFONSO
Middle Name:
Last Name:PUZZO
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 1:20921 E SMOKY HILL RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-5126
Mailing Address - Country:US
Mailing Address - Phone:303-942-1370
Mailing Address - Fax:303-942-1558
Practice Address - Street 1:20921 E SMOKY HILL RD UNIT B
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-5126
Practice Address - Country:US
Practice Address - Phone:303-942-1370
Practice Address - Fax:303-942-1558
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-23
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT3245152W00000X
FLOPC5117152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000145714Medicaid