Provider Demographics
NPI:1023088192
Name:PUTMAN, JOE R (OD)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:R
Last Name:PUTMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3703 W GREEN OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-3328
Mailing Address - Country:US
Mailing Address - Phone:817-496-6022
Mailing Address - Fax:817-496-8911
Practice Address - Street 1:3703 W GREEN OAKS BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-3328
Practice Address - Country:US
Practice Address - Phone:817-496-6022
Practice Address - Fax:817-496-8911
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2193TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A4688OtherMEDICARE GROUP PTAN
TXP00748760OtherMEDICARE RAILROAD
TX0934861 02Medicaid
TX0A4688OtherMEDICARE GROUP PTAN
TXT15395Medicare UPIN