=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164344172
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STAR MEDICAL FL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2026
-----------------------------------------------------
Last Update Date | 07/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5215 SE ABSHIER BLVD
-----------------------------------------------------
City | BELLEVIEW
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34420-3916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-245-9000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 COLLEGE ST STE E
-----------------------------------------------------
City | ATHENS
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35611-2714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-795-2559
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RCM MANAGER
-----------------------------------------------------
Name | KELLEY KOTT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 256-795-2559
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------