MEDICARE: KUGLER VISION VCS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1881168672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KUGLER VISION VCS LLC

Provider Business Mailing Address
First Line	:	17838 BURKE ST STE 100
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68118-2256
Country	:	US
Telephone Number	:	402-558-2211
Fax Number	:	402-558-2212

Provider Business Practice Location Address
First Line	:	17838 BURKE ST STE 100
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68118-2256
Country	:	US
Telephone Number	:	402-558-2211
Fax Number	:	402-558-2212

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LANCE J KUGLER
Credential	:	MD
Telephone Number	:	402-558-2211

Provider Enumeration Date	:	01/15/2019
Last Update Date	:	01/15/2019

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