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General NPI Number Information
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NPI Number | 1740267129
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Entity Type | Individual
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Provider Name | CHARLES DOUGLAS STINE OD
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Gender | Male
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Dates
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Enumeration Date | 12/28/2005
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Last Update Date | 02/19/2016
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Provider Practice Location Address
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Address Line | 4009 COMMUNITY CENTER DR
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City | WESTON
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State | WI
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Zip | 54476-4139
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Country | US
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Telephone | 715-241-2020
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Fax | 715-241-9827
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Provider Business Mailing Address
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Address Line | 4009 COMMUNITY CENTER DR
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City | WESTON
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State | WI
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Zip | 54476-4139
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Country | US
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Telephone | 715-241-2020
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Fax | 715-241-9827
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1909035
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License Number State | WI
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