Healthcare Provider Details

I. General information

NPI: 1861304123
Provider Name (Legal Business Name): STAR OPTOMETRY AL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5358 HIGHWAY 17
HELENA AL
35080-3604
US

IV. Provider business mailing address

110 COLLEGE ST STE E1
ATHENS AL
35611-2714
US

V. Phone/Fax

Practice location:
  • Phone: 205-664-7577
  • Fax: 205-891-8250
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KELLEY KOTT
Title or Position: RCM MANAGER
Credential:
Phone: 256-795-2559