Provider Demographics
NPI:1710135454
Name:MASSUCCI, MAURA E (OD)
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:E
Last Name:MASSUCCI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 BROOKTREE RD
Mailing Address - Street 2:SUITE 2800
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6600 BROOKTREE RD
Practice Address - Street 2:SUITE 2800
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9205
Practice Address - Country:US
Practice Address - Phone:724-719-2712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-06
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007305152WV0400X
PAOEG002072152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy