Provider Demographics
NPI:1174684534
Name:STELLAR VISION INC
Entity Type:Organization
Organization Name:STELLAR VISION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SUNDSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-233-0005
Mailing Address - Street 1:358 S KOELLER ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-5546
Mailing Address - Country:US
Mailing Address - Phone:920-233-0005
Mailing Address - Fax:920-233-9097
Practice Address - Street 1:358 S KOELLER ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-5546
Practice Address - Country:US
Practice Address - Phone:920-233-0005
Practice Address - Fax:920-233-9097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5461770001Medicare ID - Type UnspecifiedMEDICARE ADMINASTAR