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
1	152W00000X	Optometrist	030.0063969	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	030.0063969	OTHER	VT	VERMONT LICENSE NUMBER
2	MEDICAID 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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