MEDICARE: DR. CASSIDY ASHTON STARLING O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPT003482	GA

General Provider Information

NPI Number	:	1356055172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CASSIDY ASHTON STARLING O.D.

Provider Business Mailing Address
First Line	:	253 HIGHWAY 515 E BLDG C
Second Line	:
City	:	BLAIRSVILLE
State	:	GA
Zip	:	30512-3697
Country	:	US
Telephone Number	:	707-745-3900
Fax Number	:

Provider Business Practice Location Address
First Line	:	253 HIGHWAY 515 E BLDG C
Second Line	:
City	:	BLAIRSVILLE
State	:	GA
Zip	:	30512-3697
Country	:	US
Telephone Number	:	707-745-3900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2023
Last Update Date	:	01/06/2023

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