Healthcare Provider Details

I. General information

NPI: 1578467460
Provider Name (Legal Business Name): STAR OPTOMETRY TN, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 HARDING PL STE 104
NASHVILLE TN
37211-3924
US

IV. Provider business mailing address

110 COLLEGE ST STE E1
ATHENS AL
35611-2714
US

V. Phone/Fax

Practice location:
  • Phone: 615-485-6251
  • Fax: 615-915-2917
Mailing address:
  • Phone:
  • Fax: 615-915-2917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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