# SULLIVAN EYE CENTER, S.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104919869
- **Authorized official:** ROBERT D. SULLIVAN M.D. (PRESIDENT)
- **Authorized official phone:** (920) 734-0400

## Contact information

- **Practice address:** 1195 N CASALOMA DR, APPLETON, WI 54913-9295
- **Practice address phone:** (920) 734-0400
- **Practice address fax:** (920) 734-9054
- **Mailing address:** 1195 N CASALOMA DR, APPLETON, WI 54913-9295
- **Mailing address phone:** (920) 734-0400
- **Mailing address fax:** (920) 734-9054

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | 2483-035 | WI | — |
| 152W00000X | Optometrist | 2681-035 | WI | — |
| 152W00000X | Optometrist | 2752-035 | WI | — |
| 207W00000X | Ophthalmology Physician | 18799 | WI | Yes |

## Other

- **Enumeration date:** 10/02/2006
- **Last updated:** 09/03/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 38455900 | — | WI |