Healthcare Provider Details

I. General information

NPI: 1861989501
Provider Name (Legal Business Name): STELLAR EYE CARE SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 W COLLEGE AVE STE 1
APPLETON WI
54914-4200
US

IV. Provider business mailing address

2600 W COLLEGE AVE STE 1
APPLETON WI
54914-4200
US

V. Phone/Fax

Practice location:
  • Phone: 920-735-9914
  • Fax:
Mailing address:
  • Phone: 920-735-9914
  • Fax: 920-830-6578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2422-35
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number26341-20
License Number StateWI

VIII. Authorized Official

Name: LISA TOELLNER
Title or Position: ACCESS MANAGER
Credential:
Phone: 920-735-9914