=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255478749
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL P KUCHER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2007
-----------------------------------------------------
Last Update Date | 11/14/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 241 THREE SPRINGS DR STE 14
-----------------------------------------------------
City | WEIRTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26062-3866
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-748-2055
-----------------------------------------------------
Fax | 304-748-2054
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 241 THREE SPRINGS DR STE 14
-----------------------------------------------------
City | WEIRTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26062-3866
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-748-2055
-----------------------------------------------------
Fax | 304-748-2054
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MICHAEL P. KUCHER
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 304-748-2055
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OEG001175
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 703OD
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------