Provider Demographics
NPI:1255478749
Name:MICHAEL P KUCHER
Entity Type:Organization
Organization Name:MICHAEL P KUCHER
Other - Org Name:DOCTOR KUCHER & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:KUCHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-748-2055
Mailing Address - Street 1:241 THREE SPRINGS DR STE 14
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-3866
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001175152W00000X
WV703OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810006170Medicaid
WV0570540003Medicare NSC
WV9296331Medicare PIN