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General NPI Number Information
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NPI Number | 1861989501
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Entity Type | Organization
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Legal Business Name | STELLAR EYE CARE SC
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Dates
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Enumeration Date | 04/18/2018
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Last Update Date | 09/08/2023
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Provider Practice Location Address
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Address Line | 2600 W COLLEGE AVE STE 1
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City | APPLETON
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State | WI
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Zip | 54914-4200
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Country | US
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Telephone | 920-735-9914
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 W COLLEGE AVE STE 1
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City | APPLETON
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State | WI
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Zip | 54914-4200
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Country | US
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Telephone | 920-735-9914
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Fax |
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Authorized Official
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Title or Position | ACCESS MANAGER
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Name | LISA TOELLNER
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Credential |
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Telephone | 920-735-9914
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 26341-20
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2422-35
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License Number State | WI
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