Carl S Kukielka, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

TA0752 Issued in MD

Practice address

10025 Governor Warfield Pkwy
Suite 103
Columbia, MD 21044-3340

Phone

(410) 772-5412

Fax

(410) 828-2018

NPI assigned

Apr 6, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• University of Maryland Pediatric Associates, PA

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Baltimore, MD
  • NPI 1083933444
  NPD (past)

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1235251513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 S PRESIDENT ST",
            "address_2": "APT 634",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212024474",
            "telephone_number": "410-772-5412",
            "fax_number": "410-828-2018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10025 GOVERNOR WARFIELD PKWY",
            "address_2": "SUITE 103",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210443340",
            "telephone_number": "410-772-5412",
            "fax_number": "410-828-2018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUKIELKA",
        "first_name": "CARL",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA0752",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Calvin Kuang, NONE
• Levan Kuck
• Amberly Christine Kuebel, BCBA
• Jill Kuhns
• Igor Kukelyansky, M.D.
• Shauna Kukoyi
• Dawn M Kulak Tubb, M. AC., L.AC.
• Ajay Kumar, M.D.
• Varinder Kumar, M.D
• Megan Kuminski, LMHC

• Optometrist in Columbia, MD
• Providers in Columbia, MD by specialty
• Optometrist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.