Provider Demographics
NPI:1184971087
Name:PUTNAM, JESSICA KRISTINE (OD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:KRISTINE
Last Name:PUTNAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:KRISTINE
Other - Last Name:HORSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 207293
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7293
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:705 BAPTISTE DR
Practice Address - Street 2:STE 200
Practice Address - City:PAOLA
Practice Address - State:KS
Practice Address - Zip Code:66071-1336
Practice Address - Country:US
Practice Address - Phone:913-294-4342
Practice Address - Fax:913-294-3309
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1918152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist