Provider Demographics
NPI:1336248467
Name:PUENTE, RICHARD WILLIAM (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WILLIAM
Last Name:PUENTE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:CANAL TOWN OPTICAL
Mailing Address - Street 2:174 CANAL STREET
Mailing Address - City:CANASTOTA
Mailing Address - State:NY
Mailing Address - Zip Code:13032
Mailing Address - Country:US
Mailing Address - Phone:315-697-3334
Mailing Address - Fax:315-849-0575
Practice Address - Street 1:CANAL TOWN OPTICAL
Practice Address - Street 2:174 CANAL STREET
Practice Address - City:CANASTOTA
Practice Address - State:NY
Practice Address - Zip Code:13032
Practice Address - Country:US
Practice Address - Phone:315-697-3334
Practice Address - Fax:315-697-3423
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004449-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU22410Medicare UPIN
NYA400053562Medicare PIN