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General NPI Number Information
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NPI Number | 1326363755
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Entity Type | Organization
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Legal Business Name | NDE GROUP PLLC
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Dates
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Enumeration Date | 03/29/2010
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Last Update Date | 06/25/2010
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Provider Practice Location Address
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Address Line | 55 MAIN ST SUITE 1
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City | ESSEX JUNCTION
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State | VT
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Zip | 05452-6100
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Country | US
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Telephone | 802-879-0256
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Fax | 802-879-2401
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Provider Business Mailing Address
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Address Line | 55 MAIN ST SUITE 1
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City | ESSEX JUNCTION
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State | VT
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Zip | 05452-6100
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Country | US
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Telephone | 802-879-0256
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Fax | 802-879-2401
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. NATHAN LEE STOCKE
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Credential | O.D.
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Telephone | 802-879-0256
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 030.0063969
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License Number State | VT
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