Provider Demographics
NPI:1487628384
Name:325TH MEDICAL GROUP (USAF)
Entity Type:Organization
Organization Name:325TH MEDICAL GROUP (USAF)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF THE MEDICAL STAFF
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KULUND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-283-7717
Mailing Address - Street 1:340 MAGNOLIA CIRCLE
Mailing Address - Street 2:OPTOMETRY CLINIC
Mailing Address - City:TYNDALL AFB
Mailing Address - State:FL
Mailing Address - Zip Code:32403
Mailing Address - Country:US
Mailing Address - Phone:850-283-7005
Mailing Address - Fax:850-283-7123
Practice Address - Street 1:340 MAGNOLIA CIR
Practice Address - Street 2:OPTOMETRY CLINIC
Practice Address - City:TYNDALL A F B
Practice Address - State:FL
Practice Address - Zip Code:32403-5604
Practice Address - Country:US
Practice Address - Phone:850-283-7005
Practice Address - Fax:850-283-7123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000484261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center