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General NPI Number Information
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NPI Number | 1972508596
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Entity Type | Individual
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Provider Name | GERALD R STARCHVICK O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/20/2005
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Last Update Date | 01/10/2008
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Provider Practice Location Address
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Address Line | 1251 E MCANDREWS RD SUITE 100
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City | MEDFORD
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State | OR
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Zip | 97504-6497
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Country | US
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Telephone | 541-779-1392
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Fax | 541-779-6531
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Provider Business Mailing Address
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Address Line | 600 POWDERHORN DR
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City | JACKSONVILLE
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State | OR
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Zip | 97530-9420
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Country | US
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Telephone | 541-779-1392
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Fax | 541-779-6531
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 1563T
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | 1563T
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | 1563T
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 152WS0006X
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Taxonomy Name | Sports Vision Optometrist
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License Number | 1563T
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License Number State | OR
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Taxonomy #5
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | 1563T
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License Number State | OR
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Taxonomy #6
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Taxonomy Code | 152WX0102X
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Taxonomy Name | Occupational Vision Optometrist
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License Number | 1563T
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License Number State | OR
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