Provider Demographics
NPI:1336208131
Name:KUGEL, SVETLANA (OD)
Entity Type:Individual
Prefix:DR
First Name:SVETLANA
Middle Name:
Last Name:KUGEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 CALVIN CT
Mailing Address - Street 2:
Mailing Address - City:RIVERWOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1636
Mailing Address - Country:US
Mailing Address - Phone:847-293-0807
Mailing Address - Fax:847-293-0807
Practice Address - Street 1:35 SKOKIE BLVD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1607
Practice Address - Country:US
Practice Address - Phone:847-714-9009
Practice Address - Fax:847-714-9598
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL46008856152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist