1427166776 NPI number — DEJEAN & KUGLEN EYE ASSOCIATES LLP

Table of content: (NPI 1427166776)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427166776 NPI number — DEJEAN & KUGLEN EYE ASSOCIATES LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEJEAN & KUGLEN EYE ASSOCIATES LLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AVERY OPTICAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427166776
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 S LOOP 336 W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONROE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77304-3302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-539-4500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 S LOOP 336 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONROE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77304-3302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-539-4500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VILLEGAS
Authorized Official First Name:
SHIRIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINIC ADMINISTRATOR
Authorized Official Telephone Number:
936-539-4500

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1264720001 . This is a "D'MERC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 079598101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1427166776 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1264720001 . This is a "MEDICARE NSC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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