Provider Demographics
NPI:1255370466
Name:KUGLER, LANCE JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:LANCE
Middle Name:JOHN
Last Name:KUGLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13923 GOLD CIR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2379
Mailing Address - Country:US
Mailing Address - Phone:402-558-2211
Mailing Address - Fax:
Practice Address - Street 1:13923 GOLD CIR
Practice Address - Street 2:SUITE 101
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2379
Practice Address - Country:US
Practice Address - Phone:402-558-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE23266207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE278968Medicare ID - Type Unspecified
NEI31032Medicare UPIN