Provider Demographics
NPI:1063468213
Name:MAGISKE, MICHAEL A (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:MAGISKE
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 1:112 JONES DR
Mailing Address - Street 2:
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2920
Mailing Address - Country:US
Mailing Address - Phone:724-941-9420
Mailing Address - Fax:724-941-7187
Practice Address - Street 1:112 JONES DR
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2920
Practice Address - Country:US
Practice Address - Phone:724-941-9420
Practice Address - Fax:724-941-7187
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0EG001297152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA686731Medicare PIN
PA0811980001Medicare NSC