Healthcare Provider Details

I. General information

NPI: 1528841954
Provider Name (Legal Business Name): STAR OPTOMETRY AL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 COLLEGE ST STE B
ATHENS AL
35611-2714
US

IV. Provider business mailing address

7501 PARAGON RD STE 201
DAYTON OH
45459-5323
US

V. Phone/Fax

Practice location:
  • Phone: 256-233-2393
  • Fax: 256-233-2309
Mailing address:
  • Phone: 904-545-4465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTA WILLIAMS
Title or Position: DIRECTOR, REVENUE CYCLE MANAGEMENT
Credential:
Phone: 904-312-2295