Healthcare Provider Details

I. General information

NPI: 1972508596
Provider Name (Legal Business Name): GERALD R STARCHVICK O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date: 03/20/2006
Reactivation Date: 03/28/2006

III. Provider practice location address

1251 E MCANDREWS RD SUITE 100
MEDFORD OR
97504-6497
US

IV. Provider business mailing address

600 POWDERHORN DR
JACKSONVILLE OR
97530-9420
US

V. Phone/Fax

Practice location:
  • Phone: 541-779-1392
  • Fax: 541-779-6531
Mailing address:
  • Phone: 541-779-1392
  • Fax: 541-779-6531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1563T
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number1563T
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number1563T
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number1563T
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number1563T
License Number StateOR
# 6
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number1563T
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: