Basic Information
| Provider Information | |||||||||
| NPI: | 1003523887 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DEJEAN & KUGLEN EYE ASSOCIATES, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 S LOOP 336 W | ||||||||
| Address2: | |||||||||
| City: | CONROE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773043302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9365394500 | ||||||||
| FaxNumber: | 9365394534 | ||||||||
| Practice Location | |||||||||
| Address1: | 3361 MONTGOMERY RD | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773406416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9365394500 | ||||||||
| FaxNumber: | 9365394534 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2022 | ||||||||
| LastUpdateDate: | 11/01/2022 | ||||||||
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| AuthorizedOfficialLastName: | MCCARTY | ||||||||
| AuthorizedOfficialFirstName: | TRACY | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9365394500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | DEJEAN & KUGLEN EYE ASSOCIATES, LLP | ||||||||
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| NPICertificationDate: | 11/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.