Basic Information
| Provider Information | |||||||||
| NPI: | 1184971087 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PUTNAM | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | KRISTINE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HORSCH | ||||||||
| OtherFirstName: | JESSICA | ||||||||
| OtherMiddleName: | KRISTINE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | O.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2800 SW WANAMAKER RD | ||||||||
| Address2: | SUITE 192 | ||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666144293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852720707 | ||||||||
| FaxNumber: | 7854386777 | ||||||||
| Practice Location | |||||||||
| Address1: | 705 BAPTISTE DR | ||||||||
| Address2: | STE 200 | ||||||||
| City: | PAOLA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660711336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9132944342 | ||||||||
| FaxNumber: | 9132943309 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2012 | ||||||||
| LastUpdateDate: | 06/13/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1918 | KS | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.