Provider Demographics
NPI:1710902218
Name:MCCUSKER, MARY COLLEEN (OD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:COLLEEN
Last Name:MCCUSKER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2 E MARKET ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-2123
Mailing Address - Country:US
Mailing Address - Phone:717-248-3643
Mailing Address - Fax:717-248-1968
Practice Address - Street 1:2 E MARKET ST
Practice Address - Street 2:SUITE 2
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-2123
Practice Address - Country:US
Practice Address - Phone:717-248-3643
Practice Address - Fax:717-248-1968
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000577152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU38019Medicare UPIN
PAMC435895Medicare ID - Type Unspecified