Provider Demographics
NPI:1356235543
Name:STEFAN, NATHAN KYLE (OD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:KYLE
Last Name:STEFAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 BRIAR LN
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-2407
Mailing Address - Country:US
Mailing Address - Phone:234-802-9625
Mailing Address - Fax:
Practice Address - Street 1:270 S CLEVELAND MASSILLON RD
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-6000
Practice Address - Country:US
Practice Address - Phone:330-666-1766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.007388152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist