Healthcare Provider Details

I. General information

NPI: 1336208131
Provider Name (Legal Business Name): SVETLANA KUGEL O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 SKOKIE BLVD
NORTHBROOK IL
60062-1607
US

IV. Provider business mailing address

1935 CALVIN CT
RIVERWOODS IL
60015-1636
US

V. Phone/Fax

Practice location:
  • Phone: 847-714-9009
  • Fax: 847-714-9598
Mailing address:
  • Phone: 847-293-0807
  • Fax: 847-293-0807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number46008856
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: