Provider Demographics
NPI:1831671213
Name:PUCCI, JAMIE (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:
Last Name:PUCCI
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 1:8700 STONY POINT PKWY STE 240
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-1966
Mailing Address - Country:US
Mailing Address - Phone:048-545-9435
Mailing Address - Fax:
Practice Address - Street 1:8700 STONY POINT PKWY STE 240
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-1966
Practice Address - Country:US
Practice Address - Phone:804-545-9435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-03
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002934152W00000X, 152WV0400X, 152WL0500X
CA34066TLG152W00000X
NYTUV008895-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy