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General NPI Number Information
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NPI Number | 1629464037
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Entity Type | Organization
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Legal Business Name | STAR CITY EYE CARE
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Dates
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Enumeration Date | 04/13/2015
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Last Update Date | 04/13/2015
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Provider Practice Location Address
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Address Line | 4822 VALLEY VIEW BLVD NW STE C
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City | ROANOKE
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State | VA
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Zip | 24012-2025
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Country | US
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Telephone | 614-657-9602
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Fax |
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Provider Business Mailing Address
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Address Line | 4822 VALLEY VIEW BLVD NW STE C
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City | ROANOKE
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State | VA
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Zip | 24012-2025
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Country | US
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Telephone | 614-657-9602
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | FRANCIS M MANUGUERRA
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Credential |
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Telephone | 614-657-9602
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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 |
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License Number State |
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