Provider Demographics
NPI:1477692747
Name:STARR, JEFFREY SEYMOUR (OD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:SEYMOUR
Last Name:STARR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BAY CLUB DRIVE
Mailing Address - Street 2:SUITE 6Y
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2923
Mailing Address - Country:US
Mailing Address - Phone:718-767-6612
Mailing Address - Fax:718-767-6612
Practice Address - Street 1:2 BAY CLUB DRIVE
Practice Address - Street 2:SUITE 6Y
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-2923
Practice Address - Country:US
Practice Address - Phone:718-767-6612
Practice Address - Fax:718-767-6612
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0042421152W00000X
CT00986152W00000X
NJ4322152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist