Organization
A&K KOUKLAKIS OD P.C.
Active
Other names
Vision Quest Eye Clinics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALEXANDER HARIDIMOS KOUKLAKIS OD (PRESIDENT)
(219) 756-1700
Entity
Organization
Contact information
Practice address
521 BROADWAY, GARY, IN 46402-1910
(219) 882-9397
(219) 882-9649
Mailing address
521 BROADWAY, GARY, IN 46402-1910
(219) 882-9397
(219) 882-9649
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100215150C
—
IN
Enumeration date
04/06/2007
Last updated
11/05/2010
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