Healthcare Provider Details

I. General information

NPI: 1811978208
Provider Name (Legal Business Name): STAR OPTICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5947 PENN AVE
PITTSBURGH PA
15206
US

IV. Provider business mailing address

5947 PENN AVE
PITTSBURGH PA
15206
US

V. Phone/Fax

Practice location:
  • Phone: 412-361-8800
  • Fax: 412-363-3610
Mailing address:
  • Phone: 412-361-8800
  • Fax: 412-363-3610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. RILEY C DAVIS
Title or Position: OWNER ADMINISTRATOR
Credential:
Phone: 724-547-8199