Provider Demographics
NPI:1740273853
Name:STOCKE, NATHAN L (OD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:L
Last Name:STOCKE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030.0063969152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT030.0063969OtherVERMONT LICENSE NUMBER
VT1326363755Medicaid
VT1326363755Medicaid
VT002204301Medicare PIN