Provider Demographics
NPI:1598877532
Name:MUCK, DUANE C (OD)
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:C
Last Name:MUCK
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 1:101 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OSBORNE
Mailing Address - State:KS
Mailing Address - Zip Code:67473-2402
Mailing Address - Country:US
Mailing Address - Phone:785-346-5437
Mailing Address - Fax:785-346-5438
Practice Address - Street 1:101 W MAIN ST
Practice Address - Street 2:
Practice Address - City:OSBORNE
Practice Address - State:KS
Practice Address - Zip Code:67473-2402
Practice Address - Country:US
Practice Address - Phone:785-346-5437
Practice Address - Fax:785-346-5438
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1069-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KST43712Medicare UPIN
KS0334380001Medicare NSC