Provider Demographics
NPI:1881689198
Name:PUCKETT, FRANK E (OD)
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:E
Last Name:PUCKETT
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1860 WOODMOOR DR
Mailing Address - Street 2:STE 103
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-9093
Mailing Address - Country:US
Mailing Address - Phone:719-488-2042
Mailing Address - Fax:719-488-0965
Practice Address - Street 1:1860 WOODMOOR DR
Practice Address - Street 2:STE 103
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9093
Practice Address - Country:US
Practice Address - Phone:719-488-2042
Practice Address - Fax:719-488-0965
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2016-03-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO1007152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP01292813OtherRAILROAD MEDICARE
CO08010076Medicaid
CO08010076Medicaid
COCF2013Medicare PIN