Healthcare Provider Details

I. General information

NPI: 1396435657
Provider Name (Legal Business Name): ANTHONY STARR OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 ROUTE 73 N STE 3
MARLTON NJ
08053-3466
US

IV. Provider business mailing address

701 ROUTE 73 N STE 3
MARLTON NJ
08053-3466
US

V. Phone/Fax

Practice location:
  • Phone: 856-988-1118
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00720100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: