Healthcare Provider Details

I. General information

NPI: 1639081177
Provider Name (Legal Business Name): CHRISTINA KUCHTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 ROUTE 315 HWY
PITTSTON PA
18640-3903
US

IV. Provider business mailing address

41 FERRY ST
PLYMOUTH PA
18651-3118
US

V. Phone/Fax

Practice location:
  • Phone: 570-883-9696
  • Fax:
Mailing address:
  • Phone: 570-883-9696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number255305
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: