Organization
MONUMENT VISION CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FRANK E PUCKETT O.D. (OPTOMETRIST/OWNER)
(719) 488-2042
Entity
Organization
Contact information
Practice address
1860 WOODMOOR DR, SUITE 103, MONUMENT, CO 80132-9093
(719) 488-2042
(719) 488-0965
Mailing address
1860 WOODMOOR DR, SUITE 103, MONUMENT, CO 80132-9093
(719) 488-2042
(719) 488-0965
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DU5449
RAILROAD MEDICARE
CO
Enumeration date
12/20/2010
Last updated
05/19/2014
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