NPIMap

Organization Active NPI

Stine Eye Center, LLC

  • Optometrist
  • Weston, WI
National Provider Identifier
1043383755
Registry record updated Apr 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1909035 Issued in WI
Legal business name
STINE EYE CENTER, LLC
Practice address
4009 Community Center Drive
#100
Weston, WI 54476
Phone
(715) 241-2020
Fax
(715) 241-9827
NPI assigned
Nov 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Charles Douglas Stine, ODNPI 1740267129
Title
Ceo
Phone
(715) 241-2020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 1909035 WI Primary

Addresses

Primary practice location

4009 Community Center Drive
#100
Weston, WI 54476

Mailing address

4009 Community Center Drive
#100
Weston, WI 54476-2264
Phone (715) 241-2020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040909001283 WI Part B Supplier - Clinic/Group Practice 1759357718 Receives reassigned benefits from 7 practitioners
Practice locations: Weston, WI
O20100930079069 WI DME Supplier - Physician - OptometristDME Supplier - Optician 1759357718 Practice locations: Weston, WI

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Stine Eye Center, LLC4009 Community Center Dr, Weston, WI 54476-4139(715) 241-2020 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since May 1, 2004

National Provider Directory

National Provider Directory

Locations

5404 Alderson St
Ste 100
Schofield, WI 54476
Phone (715) 241-2020

4009 Community Center Dr
#100
Weston, WI 54476
Phone (715) 241-2020

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270684800000",
    "number": "1043383755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4009 COMMUNITY CENTER DRIVE",
            "address_2": "#100",
            "city": "WESTON",
            "state": "WI",
            "postal_code": "544762264",
            "telephone_number": "715-241-2020",
            "fax_number": "715-241-9827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4009 COMMUNITY CENTER DRIVE",
            "address_2": "#100",
            "city": "WESTON",
            "state": "WI",
            "postal_code": "54476",
            "telephone_number": "715-241-2020",
            "fax_number": "715-241-9827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STINE EYE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2010-04-08",
        "status": "A",
        "authorized_official_last_name": "STINE",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "DOUGLAS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "715-241-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WI",
            "license": "1909035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Weston, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.