Provider Demographics
NPI:1588877989
Name:SIRASKY, PUNAM S (OD)
Entity type:Individual
Prefix:DR
First Name:PUNAM
Middle Name:S
Last Name:SIRASKY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:PUNAM
Other - Middle Name:
Other - Last Name:SAINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2819 DIXIE HWY
Mailing Address - Street 2:NEXT TO LENSCRAFTERS
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017
Mailing Address - Country:US
Mailing Address - Phone:589-331-3124
Mailing Address - Fax:859-331-4895
Practice Address - Street 1:2819 DIXIE HWY
Practice Address - Street 2:NEXT TO LENSCRAFTERS
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017
Practice Address - Country:US
Practice Address - Phone:859-331-3124
Practice Address - Fax:859-331-4895
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1166152W00000X
KY1912DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1588877989OtherNPI