MEDICARE: DR. BRIAN L STARR 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	3826 T-665	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588660567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN L STARR O.D.

Provider Business Mailing Address
First Line	:	58 W HIGH ST
Second Line	:
City	:	MOUNT GILEAD
State	:	OH
Zip	:	43338-1213
Country	:	US
Telephone Number	:	419-947-8330
Fax Number	:	419-947-8355

Provider Business Practice Location Address
First Line	:	58 W HIGH ST
Second Line	:
City	:	MOUNT GILEAD
State	:	OH
Zip	:	43338-1213
Country	:	US
Telephone Number	:	419-947-8330
Fax Number	:	419-947-8355

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	02/15/2011

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