Provider Demographics
NPI:1346446820
Name:ROLLINS EYECARE SERVICES SC
Entity Type:Organization
Organization Name:ROLLINS EYECARE SERVICES SC
Other - Org Name:STERLING OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:715-341-0198
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI 1697152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38528200Medicaid
WIT63132Medicare UPIN
WI0430960001Medicare NSC
WI38528200Medicaid