Healthcare Provider Details

I. General information

NPI: 1760762835
Provider Name (Legal Business Name): BRYAN NATHAN KUDER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4009 OLD DENTON RD STE 124
CARROLLTON TX
75007
US

IV. Provider business mailing address

4009 OLD DENTON RD STE 124
CARROLLTON TX
75007-1070
US

V. Phone/Fax

Practice location:
  • Phone: 972-939-6567
  • Fax: 972-939-6268
Mailing address:
  • Phone: 972-939-6567
  • Fax: 972-939-6268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7822TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: