Provider Demographics
NPI:1861989501
Name:STELLAR EYE CARE SC
Entity type:Organization
Organization Name:STELLAR EYE CARE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOELLNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-735-9914
Mailing Address - Street 1:2600 W COLLEGE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-4200
Mailing Address - Country:US
Mailing Address - Phone:920-735-9914
Mailing Address - Fax:
Practice Address - Street 1:2600 W COLLEGE AVE STE 1
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-4200
Practice Address - Country:US
Practice Address - Phone:920-735-9914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-18
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26341-20207W00000X
WI2422-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty