Provider Demographics
NPI:1104230663
Name:DUGAN, KATHRYN (OD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:DUGAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:31333 TEMECULA PKWY
Mailing Address - Street 2:SUITE #C10-140
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-6820
Mailing Address - Country:US
Mailing Address - Phone:951-302-1331
Mailing Address - Fax:866-812-6094
Practice Address - Street 1:31333 TEMECULA PKWY
Practice Address - Street 2:SUITE #C10-140
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-6820
Practice Address - Country:US
Practice Address - Phone:951-302-1331
Practice Address - Fax:866-812-6094
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14952152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy