Provider Demographics
NPI:1629636105
Name:MCCARTY, STEVEN MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MICHAEL
Last Name:MCCARTY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:772 ELEMENT WAY APT 217
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-4681
Mailing Address - Country:US
Mailing Address - Phone:815-861-4133
Mailing Address - Fax:
Practice Address - Street 1:2314 LINEVILLE RD STE 104
Practice Address - Street 2:
Practice Address - City:SUAMICO
Practice Address - State:WI
Practice Address - Zip Code:54313-8860
Practice Address - Country:US
Practice Address - Phone:920-434-5845
Practice Address - Fax:920-434-5228
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3555-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist