Provider Demographics
NPI:1942878640
Name:MUCKIN, ANDREW J (OD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:MUCKIN
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 AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1982
Mailing Address - Country:US
Mailing Address - Phone:570-340-8053
Mailing Address - Fax:
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:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003788152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist