Provider Demographics
NPI:1427116375
Name:NATALE, STUART W (OD)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:W
Last Name:NATALE
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 1:289 E GREEN BAY AVE
Mailing Address - Street 2:
Mailing Address - City:SAUKVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53080
Mailing Address - Country:US
Mailing Address - Phone:262-268-2007
Mailing Address - Fax:
Practice Address - Street 1:289 E GREEN BAY AVE
Practice Address - Street 2:
Practice Address - City:SAUKVILLE
Practice Address - State:WI
Practice Address - Zip Code:53080
Practice Address - Country:US
Practice Address - Phone:262-268-2007
Practice Address - Fax:262-268-8279
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI2716035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38604600Medicaid
U63670Medicare UPIN
WI47234Medicare ID - Type Unspecified