Provider Demographics
NPI:1992791438
Name:PAUMEN, KERRY JO (CERTIFIED OPTICIAN)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:JO
Last Name:PAUMEN
Suffix:
Gender:F
Credentials:CERTIFIED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-3209
Mailing Address - Country:US
Mailing Address - Phone:970-565-1580
Mailing Address - Fax:970-565-8203
Practice Address - Street 1:48 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3209
Practice Address - Country:US
Practice Address - Phone:970-565-1580
Practice Address - Fax:970-565-8203
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO152435156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08003899Medicaid