Healthcare Provider Details

I. General information

NPI: 1255370466
Provider Name (Legal Business Name): LANCE JOHN KUGLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13923 GOLD CIR SUITE 101
OMAHA NE
68144-2379
US

IV. Provider business mailing address

13923 GOLD CIR SUITE 101
OMAHA NE
68144-2379
US

V. Phone/Fax

Practice location:
  • Phone: 402-558-2211
  • Fax:
Mailing address:
  • Phone: 402-558-2211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberNE23266
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: