Individual
STEPHEN RANDALL MARION
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1100 MADISON AVE, FORT ATKINSON, WI 53538-1374
(920) 563-8468
(920) 563-0178
Mailing address
1100 MADISON AVE, FORT ATKINSON, WI 53538-1374
(920) 563-8468
(920) 563-0178
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1417-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1006590
PHYSICIANS PLUS
WI
01
—
1560
DEAN HEALTH INSURANCE
WI
01
—
2149813
UNITED HEALTHCARE
WI
05
—
38572400
—
WI
01
—
MARIOSRA
MERCYCARE
WI
Enumeration date
05/15/2006
Last updated
05/05/2008
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