Active NPI
Kenneth Stuart Stoller, OD
- Optometrist
- Lincoln Park, MI
National Provider Identifier
1326080169
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 4901002772
- Practice address
- 1755 Dix Hwy
Lincoln Park, MI 48146-1412 - Phone
- (313) 382-9650
- Fax
- (313) 382-3428
- NPI assigned
- Jun 12, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4901002772 | MI | Primary |
Addresses
Primary practice location
1755 Dix Hwy
Lincoln Park, MI 48146-1412
Mailing address
39259 Heatherbrook Dr
Farmington Hills, MI 48331-2916
Phone (313) 382-9650
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eye Institute of South Eastern Michigan | Optometrist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Optometrist
- River Rouge, MI
- NPI 1831304765
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1326080169",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "39259 HEATHERBROOK DR",
"city": "FARMINGTON HILLS",
"state": "MI",
"postal_code": "483312916",
"telephone_number": "313-382-9650",
"fax_number": "313-382-3428"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1755 DIX HWY",
"city": "LINCOLN PARK",
"state": "MI",
"postal_code": "481461412",
"telephone_number": "313-382-9650",
"fax_number": "313-382-3428"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STOLLER",
"first_name": "KENNETH",
"middle_name": "STUART",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-12",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MI",
"license": "4901002772",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lincoln Park, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.