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General NPI Number Information
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NPI Number | 1730755984
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Entity Type | Organization
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Legal Business Name | STAAR VISIONS, LLC
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Dates
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Enumeration Date | 05/28/2021
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Last Update Date | 05/28/2021
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Provider Practice Location Address
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Address Line | 7510 SOMERSBY DR
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City | SUMMERFIELD
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State | NC
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Zip | 27358-8292
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Country | US
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Telephone | 336-465-0621
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Fax |
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Provider Business Mailing Address
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Address Line | 1258 WINSLOW AVE APT A
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City | ASHEBORO
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State | NC
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Zip | 27205-5162
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Country | US
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Telephone | 336-465-0621
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KRISTINA R TRACY
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Credential |
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Telephone | 336-465-0621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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