Provider Demographics
NPI:1770628489
Name:STANKEVYCH, NATALIE A (OD)
Entity type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:A
Last Name:STANKEVYCH
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 1:923 ELIZA ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301
Mailing Address - Country:US
Mailing Address - Phone:920-965-4700
Mailing Address - Fax:920-431-7024
Practice Address - Street 1:923 ELIZA ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3234
Practice Address - Country:US
Practice Address - Phone:920-965-4700
Practice Address - Fax:920-965-4701
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2819-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38614200Medicaid
WI000207100OtherMEDICARE PTAN
WI38614200Medicaid