Provider Demographics
NPI:1205984051
Name:JAIN, PUNIT (OD)
Entity type:Individual
Prefix:
First Name:PUNIT
Middle Name:
Last Name:JAIN
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 1:6 C TUPELO DR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065
Mailing Address - Country:US
Mailing Address - Phone:518-373-8656
Mailing Address - Fax:
Practice Address - Street 1:3065 ROUTE 50
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2960
Practice Address - Country:US
Practice Address - Phone:518-583-0202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY6273152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV01105Medicare UPIN
NYRA4202Medicare ID - Type Unspecified