Provider Demographics
NPI:1215992078
Name:CUCHER, CRAIG J
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:J
Last Name:CUCHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 WESTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-5601
Mailing Address - Country:US
Mailing Address - Phone:310-477-0677
Mailing Address - Fax:310-477-1677
Practice Address - Street 1:1545 WESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-5601
Practice Address - Country:US
Practice Address - Phone:310-477-0677
Practice Address - Fax:310-477-1677
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12068T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOP12068Medicare PIN
CAU78101Medicare UPIN
CA5767610001Medicare NSC