Provider Demographics
NPI:1487377925
Name:DR BUGENSKE EYECARE, LLC
Entity type:Organization
Organization Name:DR BUGENSKE EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUGENSKE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:470-277-4902
Mailing Address - Street 1:2230 TOWNE LAKE PKWY BLDG 600 STE 100
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189
Mailing Address - Country:US
Mailing Address - Phone:770-591-3511
Mailing Address - Fax:770-591-3752
Practice Address - Street 1:2230 TOWNE LAKE PKWY BLDG 600 STE 100
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-3018
Practice Address - Country:US
Practice Address - Phone:770-591-3511
Practice Address - Fax:770-591-3752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty