Organization
SULLIVAN EYE CENTER, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT D. SULLIVAN M.D. (PRESIDENT)
(920) 734-0400
Entity
Organization
Contact information
Practice address
1195 N CASALOMA DR, APPLETON, WI 54913-9295
(920) 734-0400
(920) 734-9054
Mailing address
1195 N CASALOMA DR, APPLETON, WI 54913-9295
(920) 734-0400
(920) 734-9054
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
2483-035
WI
152W00000X
Optometrist
2681-035
WI
152W00000X
Optometrist
2752-035
WI
207W00000X
Ophthalmology Physician
Primary
18799
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38455900
—
WI
Enumeration date
10/02/2006
Last updated
09/03/2008
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