Provider Demographics
NPI:1699320333
Name:DLUGENSKY, EDMUND LOUIS JR (OD)
Entity type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:LOUIS
Last Name:DLUGENSKY
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 SOUTHMONT DR
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-8328
Mailing Address - Country:US
Mailing Address - Phone:940-765-5231
Mailing Address - Fax:
Practice Address - Street 1:2430 S INTERSTATE 35 E
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-4986
Practice Address - Country:US
Practice Address - Phone:940-765-5231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2205152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist