=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669340253
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STAR OPTOMETRY TN, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2025
-----------------------------------------------------
Last Update Date | 10/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1822 HUNTSVILLE HWY STE D
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37334-3788
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-433-1370
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7501 PARAGON RD STE 201
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45459-5323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING MANAGER
-----------------------------------------------------
Name | RACHEL MARIE ARNOLD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 256-321-1828
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------