Provider Demographics
NPI:1427166776
Name:DEJEAN & KUGLEN EYE ASSOCIATES LLP
Entity type:Organization
Organization Name:DEJEAN & KUGLEN EYE ASSOCIATES LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHIRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLEGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-539-4500
Mailing Address - Street 1:400 S LOOP 336 W
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3302
Mailing Address - Country:US
Mailing Address - Phone:936-539-4500
Mailing Address - Fax:
Practice Address - Street 1:400 S LOOP 336 W
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3302
Practice Address - Country:US
Practice Address - Phone:936-539-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEJEAN & KUGLEN EYE ASSOCIATES LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-28
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1264720001OtherD'MERC
TX079598101Medicaid
TX1427166776OtherNPI
TX1264720001OtherMEDICARE NSC