MEDICARE: STAR OPTOMETRY TN, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1336922764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAR OPTOMETRY TN, PC

Provider Business Mailing Address
First Line	:	110 COLLEGE ST STE E
Second Line	:
City	:	ATHENS
State	:	AL
Zip	:	35611-2714
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5243 LITTLE DEBBIE PKWY STE 124
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-4514
Country	:	US
Telephone Number	:	423-468-3305
Fax Number	:

Authorized Official
Title or Position	:	RCM MANAGER
Name	:	KELLEY KOTT
Credential	:
Telephone Number	:	256-795-2559

Provider Enumeration Date	:	08/17/2023
Last Update Date	:	06/16/2026

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