Provider Demographics
NPI:1386059566
Name:KULL, KURT GEORGE (OD)
Entity type:Individual
Prefix:DR
First Name:KURT
Middle Name:GEORGE
Last Name:KULL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2900 W CYPRESS CREEK RD
Mailing Address - Street 2:STE 4
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1715
Mailing Address - Country:US
Mailing Address - Phone:954-979-2407
Mailing Address - Fax:954-979-8988
Practice Address - Street 1:9851 S MILITARY TRL
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-3237
Practice Address - Country:US
Practice Address - Phone:561-742-8701
Practice Address - Fax:561-742-4212
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2015-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5008152W00000X
MDTA2419152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist