Provider Demographics
NPI:1417960576
Name:KAUFMAN, STUART (OD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:
Last Name:KAUFMAN
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 1:200 MIFFLIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503
Mailing Address - Country:US
Mailing Address - Phone:570-342-3145
Mailing Address - Fax:570-344-1309
Practice Address - Street 1:16749 STATE ROUTE 706 STE 4
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:PA
Practice Address - Zip Code:18801-6502
Practice Address - Country:US
Practice Address - Phone:570-278-2279
Practice Address - Fax:570-278-4058
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000837152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001785548Medicaid
20529OtherGEISINGER HEALTH PLAN
506554OtherAETNA
072374OtherFIRST PRIORITY HEALTH
KA287932OtherHIGH MARK BLUE SHIELD
410041715OtherRAIL ROAD MEDICARE
PA001785548Medicaid
T26755Medicare UPIN