Provider Demographics
NPI:1811031966
Name:KUKLA, KEVIN LEO (OD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LEO
Last Name:KUKLA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7430 ASTOR AVE
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-3139
Mailing Address - Country:US
Mailing Address - Phone:630-362-8592
Mailing Address - Fax:
Practice Address - Street 1:3104 N LEWIS AVE
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60087-2231
Practice Address - Country:US
Practice Address - Phone:847-599-1185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist