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NPI Code Detail

MEDICARE: NATHAN L STOCKE OD

MEDICARE:   NATHAN L STOCKE  OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist030.0063969VT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1030.0063969OTHERVTVERMONT LICENSE NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1740273853
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATHAN L STOCKE OD
Provider Business Mailing Address
First Line : 55 MAIN ST
Second Line : SUITE 1
City : ESSEX JUNCTION
State : VT
Zip : 05452-6100
Country : US
Telephone Number : 802-879-0256
Fax Number : 802-879-2401
Provider Business Practice Location Address
First Line : 55 MAIN ST
Second Line : SUITE 1
City : ESSEX JUNCTION
State : VT
Zip : 05452-6100
Country : US
Telephone Number : 802-879-0256
Fax Number : 802-879-2401
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2005
Last Update Date : 03/07/2023

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