Provider Demographics
NPI:1285670588
Name:STINVIL, VENESSA LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:VENESSA
Middle Name:LYNN
Last Name:STINVIL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SAGAMORE LN
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-6014
Mailing Address - Country:US
Mailing Address - Phone:631-836-9100
Mailing Address - Fax:631-253-4101
Practice Address - Street 1:4 SAGAMORE LN
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-6014
Practice Address - Country:US
Practice Address - Phone:631-836-9100
Practice Address - Fax:631-253-4101
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004477A152W00000X
PAOEG003729152W00000X
FLTPOP37152W00000X
NYTUV005425152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01452753Medicaid
NY235OtherCSEA
NY51597OtherDAVIS VISION
NY01452753Medicaid