Provider Demographics
NPI:1538150487
Name:PUTNOI, ERIC L (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:L
Last Name:PUTNOI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HOPE AVENUE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453
Mailing Address - Country:US
Mailing Address - Phone:781-894-2020
Mailing Address - Fax:781-891-7936
Practice Address - Street 1:20 HOPE AVENUE
Practice Address - Street 2:SUITE 212
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453
Practice Address - Country:US
Practice Address - Phone:781-894-2020
Practice Address - Fax:781-891-7936
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223727207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA494180OtherTUFTS HEALTH PLAN
MA2105586Medicaid
MAAA45657OtherHARVARD PILGRIM HEALTH CA
MAA38871Medicare ID - Type Unspecified
MAI36249Medicare UPIN