Provider Demographics
NPI:1235125436
Name:ROLLINS, STEPHEN RAY (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:RAY
Last Name:ROLLINS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-1843
Mailing Address - Country:US
Mailing Address - Phone:715-341-0198
Mailing Address - Fax:715-343-8255
Practice Address - Street 1:200 DIVISION ST
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-1843
Practice Address - Country:US
Practice Address - Phone:715-341-0198
Practice Address - Fax:715-343-8255
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2008-04-04
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
WI1697152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38528200Medicaid