Provider Demographics
NPI:1316535107
Name:VISION STAR OPTOMETRY LLC
Entity Type:Organization
Organization Name:VISION STAR OPTOMETRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:RISHI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-651-8832
Mailing Address - Street 1:4671 S UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3817
Mailing Address - Country:US
Mailing Address - Phone:954-434-4671
Mailing Address - Fax:954-434-4556
Practice Address - Street 1:1031 IVES DAIRY RD STE 133
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-2538
Practice Address - Country:US
Practice Address - Phone:305-651-8832
Practice Address - Fax:305-651-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-06
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty