Healthcare Provider Details

I. General information

NPI: 1376938811
Provider Name (Legal Business Name): KUGEL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S RAND RD WALMART VISION
LAKE ZURICH IL
60047-2465
US

IV. Provider business mailing address

1935 CALVIN CT
RIVERWOODS IL
60015-1636
US

V. Phone/Fax

Practice location:
  • Phone: 847-550-0398
  • Fax:
Mailing address:
  • Phone: 847-331-3421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. SVETLANA KUGEL
Title or Position: PRESIDENT
Credential: OD
Phone: 847-331-3421