Individual
ALEXANDER H KOUKLAKIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2294 W 81ST AVE, MERRILLVILLE, IN 46410-5339
(219) 756-1700
Mailing address
2294 W 81ST AVE, MERRILLVILLE, IN 46410-5339
(219) 756-1700
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
Primary
18002297B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100215150
—
IN
Enumeration date
11/08/2006
Last updated
12/27/2007
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