Provider Demographics
NPI:1831203884
Name:KUCHER, MICHAEL P (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:KUCHER
Suffix:
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 1:126 OLD QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:PA
Mailing Address - Zip Code:15026-1546
Mailing Address - Country:US
Mailing Address - Phone:304-748-2055
Mailing Address - Fax:304-748-2054
Practice Address - Street 1:241 THREE SPRINGS DR STE 14
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-3866
Practice Address - Country:US
Practice Address - Phone:304-748-2055
Practice Address - Fax:304-748-2054
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001175152W00000X
WV703OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV015061800Medicaid
WV0570540001Medicare NSC
WV0570540003Medicare NSC
WV0848271Medicare PIN
WV015061800Medicaid
PA111742Medicare PIN
PA0570540002Medicare NSC
WVT28796Medicare UPIN