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General NPI Number Information
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NPI Number | 1598068991
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Entity Type | Organization
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Legal Business Name | PRESTON H. STARKS FAMILY EYECARE LLC
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Dates
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Enumeration Date | 12/07/2010
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Last Update Date | 02/04/2011
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Provider Practice Location Address
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Address Line | 12100 LEM TURNER RD
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City | JACKSONVILLE
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State | FL
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Zip | 32218-2304
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Country | US
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Telephone | 904-564-4177
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Fax | 904-641-8072
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Provider Business Mailing Address
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Address Line | 2641 LANTANA LAKES CT
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City | JACKSONVILLE
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State | FL
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Zip | 32246-4634
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Country | US
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Telephone | 904-564-4177
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Fax | 904-641-8072
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. PRESTON HENRY STARKS
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Credential | OD
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Telephone | 904-564-4177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC 2779
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License Number State | FL
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