Provider Demographics
NPI:1578735338
Name:WAYNE A MUCK, O.D.
Entity Type:Organization
Organization Name:WAYNE A MUCK, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MUCK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-462-0177
Mailing Address - Street 1:222 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2619
Mailing Address - Country:US
Mailing Address - Phone:732-462-0177
Mailing Address - Fax:732-462-5680
Practice Address - Street 1:222 SOUTH ST
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2619
Practice Address - Country:US
Practice Address - Phone:732-462-0177
Practice Address - Fax:732-462-5680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3009332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0254650001Medicare UPIN
NJ0254650001Medicare NSC