Kulak Oculofacial LLC

Primary specialty

Ophthalmic Plastic and Reconstructive Surgery PhysicianTaxonomy code 207WX0200X

Legal business name

KULAK OCULOFACIAL LLC

Practice address

530 Jacksonville Dr
Jacksonville Beach, FL 32250-3813

Phone

(904) 775-5275

Fax

(904) 853-1414

NPI assigned

Aug 5, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Amy Kulak, MDNPI 1689823783

Title

Owner/Authorized Official

Phone

(917) 715-2599

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Amy Kulak, MD

  • Ophthalmic Plastic and Reconstructive Surgery Physician
  • Jacksonville Beach, FL
  • NPI 1689823783

  Ophthalmology

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1628121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706227200000",
    "number": "1013681774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 JACKSONVILLE DR",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322503813",
            "telephone_number": "904-775-5275",
            "fax_number": "904-853-1414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 JACKSONVILLE DR",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322503813",
            "telephone_number": "904-775-5275",
            "fax_number": "904-853-1414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KULAK OCULOFACIAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-05",
        "last_updated": "2024-01-26",
        "certification_date": "2024-01-26",
        "status": "A",
        "authorized_official_last_name": "KULAK",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "OWNER/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "917-715-2599",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207WX0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lanna Koop, OTR
• Ellen Kordonowy, MA
• Michelle M Krawczyk, ARNP
• Angela Mahoney Kreidl, MS OTRL
• Michael D Kring, PA
• Amy Kulak, MD
• Lillian Kendall Kulik, PA-C
• La Quinn MD PA
• La Quinn MD PA
• Efstratios Demetrios Lagoutaris, DPM

• Ophthalmic Plastic and Reconstructive Surgery Physician in Jacksonville Beach, FL
• Providers in Jacksonville Beach, FL by specialty
• Ophthalmic Plastic and Reconstructive Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.