Provider Demographics
NPI:1518855816
Name:STINE, GABRIELLA GRACE (OD)
Entity type:Individual
Prefix:DR
First Name:GABRIELLA
Middle Name:GRACE
Last Name:STINE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:4009 COMMUNITY CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-4139
Mailing Address - Country:US
Mailing Address - Phone:715-241-2020
Mailing Address - Fax:715-241-9827
Practice Address - Street 1:4009 COMMUNITY CENTER DR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-4139
Practice Address - Country:US
Practice Address - Phone:715-241-2020
Practice Address - Fax:715-241-9827
Is Sole Proprietor?:No
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4081-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist