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General NPI Number Information
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NPI Number | 1942878640
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Entity Type | Individual
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Provider Name | ANDREW J MUCKIN OD
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Gender | Male
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Dates
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Enumeration Date | 06/17/2021
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Last Update Date | 12/01/2022
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Provider Practice Location Address
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Address Line | 16749 STATE ROUTE 706 STE 4
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City | MONTROSE
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State | PA
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Zip | 18801-6502
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Country | US
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Telephone | 570-278-2279
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Fax |
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Provider Business Mailing Address
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Address Line | 200 MIFFLIN AVE
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City | SCRANTON
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State | PA
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Zip | 18503-1982
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Country | US
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Telephone | 570-340-8053
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OEG003788
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License Number State | PA
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