Individual
DR. STEVEN LEE NOTTLESON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1545 MAIN ST, MARINETTE, WI 54143-1334
(715) 735-3012
(715) 735-3636
Mailing address
2782 S MEMORIAL DR, GREEN BAY, WI 54313-6204
(920) 562-0408
(920) 494-3705
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
Primary
1960-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1871667220
GROUP NPI
—
05
—
38523200
—
WI
01
—
39-1548019
TAX ID
—
01
—
DG8179
GROUP PTAN
—
Enumeration date
03/22/2006
Last updated
08/03/2021
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