Individual provider Active NPI

Natalie A Stankevych, O.D.

  • Optometrist
  • Green Bay, WI
National Provider Identifier
1770628489
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2819-035 Issued in WI
Practice address
923 Eliza St
Green Bay, WI 54301-3234
Phone
(920) 965-4700
Fax
(920) 965-4701
NPI assigned
Feb 20, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2819-035 WI Primary

Addresses

Primary practice location

923 Eliza St
Green Bay, WI 54301-3234

Mailing address

923 Eliza St
Green Bay, WI 54301
Phone (920) 965-4700

Other identifiers 2

IdentifierTypeStateIssuer
38614200MedicaidWI
000207100OtherWIMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031209000856 WI Practitioner - Optometry 5092611228 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eye Associates of Green Bay, SCGroup PAC ID 2365654977, 2 clinicians

Practice addresses (Care Compare)

2020 Riverside Dr
Suite 201
Green Bay, WI 54301-2300
Phone (920) 965-4700

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery20

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2819-035WIMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Eye Associates of Green Bay, SC Optometrist CurrentSince Oct 1, 2001 Accepting new patients
Pamela G Dobson DO Optometrist Past Accepting new patients

Locations

923 Eliza St
Green Bay, WI 54301
Phone (920) 965-4700

2020 Riverside Dr
Ste 201
Green Bay, WI 54301
Phone (920) 965-4700

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1770628489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "923 ELIZA ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "54301",
            "telephone_number": "920-965-4700",
            "fax_number": "920-431-7024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "923 ELIZA ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013234",
            "telephone_number": "920-965-4700",
            "fax_number": "920-965-4701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STANKEVYCH",
        "first_name": "NATALIE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-20",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2819-035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38614200",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "000207100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.