Basic Information
| Provider Information | |||||||||
| NPI: | 1306966379 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STECK | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | MARTHA | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13980 W SUN VALLEY DR | ||||||||
| Address2: | |||||||||
| City: | NEW BERLIN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531516882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4145295284 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10800 N PORT WASHINGTON RD | ||||||||
| Address2: | |||||||||
| City: | MEQUON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530925007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2622414848 | ||||||||
| FaxNumber: | 2622419865 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2007 | ||||||||
| LastUpdateDate: | 04/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WC0802X | 2342 | WI | N | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management | 152W00000X | 2342 | WI | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 2342 | 01 | WI | STATE LICENSE | OTHER |