Healthcare Provider Details

I. General information

NPI: 1851820609
Provider Name (Legal Business Name): VISION STAR OPTOMETRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4671 S UNIVERSITY DR
DAVIE FL
33328-3817
US

IV. Provider business mailing address

4671 S UNIVERSITY DR
DAVIE FL
33328-3817
US

V. Phone/Fax

Practice location:
  • Phone: 305-665-3279
  • Fax:
Mailing address:
  • Phone: 954-434-4671
  • Fax: 954-434-4556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: RISHI SHAH
Title or Position: PRESIDENT
Credential: OD
Phone: 703-861-2789