Provider Demographics
NPI:1922165067
Name:J ALLEN PUMA OD PC
Entity Type:Organization
Organization Name:J ALLEN PUMA OD PC
Other - Org Name:ADVANCED VISION CARE AND CONTACT LENS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:PUMA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:802-658-7610
Mailing Address - Street 1:30 MAIN ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-8438
Mailing Address - Country:US
Mailing Address - Phone:802-658-7610
Mailing Address - Fax:
Practice Address - Street 1:30 MAIN ST
Practice Address - Street 2:SUITE 120
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8438
Practice Address - Country:US
Practice Address - Phone:802-658-7610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTVN1000Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER