Provider Demographics
NPI:1215420294
Name:STOLLE, KASEY (OD)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:STOLLE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:740 W GREEN MEADOWS DR STE 300
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-3098
Mailing Address - Country:US
Mailing Address - Phone:317-477-3937
Mailing Address - Fax:317-477-3939
Practice Address - Street 1:740 W GREEN MEADOWS DR STE 300
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-3098
Practice Address - Country:US
Practice Address - Phone:317-477-3937
Practice Address - Fax:317-477-3939
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004091A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist