Provider Demographics
NPI:1326363755
Name:NDE GROUP PLLC
Entity Type:Organization
Organization Name:NDE GROUP PLLC
Other - Org Name:APPLE VALLEY VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:STOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:802-879-0256
Mailing Address - Street 1:55 MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-6100
Mailing Address - Country:US
Mailing Address - Phone:802-879-0256
Mailing Address - Fax:802-879-2401
Practice Address - Street 1:55 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-6100
Practice Address - Country:US
Practice Address - Phone:802-879-0256
Practice Address - Fax:802-879-2401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030.0063969152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1017443Medicaid