Healthcare Provider Details

I. General information

NPI: 1669612891
Provider Name (Legal Business Name): CRAIG CHARLES KUGLEN SR. M.D,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2009
Last Update Date: 02/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 ROCKCLIFF RD
AUSTIN TX
78746-1205
US

IV. Provider business mailing address

1310 ROCKCLIFF RD
AUSTIN TX
78746-1205
US

V. Phone/Fax

Practice location:
  • Phone: 512-327-0319
  • Fax:
Mailing address:
  • Phone: 512-327-0319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD0574
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: