Provider Demographics
NPI:1841311032
Name:PUNDY, LARISSA NADIA (OD)
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:NADIA
Last Name:PUNDY
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 1:307 N BEVERLY LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-6242
Mailing Address - Country:US
Mailing Address - Phone:847-590-1097
Mailing Address - Fax:
Practice Address - Street 1:307 N BEVERLY LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-6242
Practice Address - Country:US
Practice Address - Phone:847-590-1097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-008060152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist