Provider Demographics
NPI:1578742391
Name:TOMY STARCK MD PA
Entity Type:Organization
Organization Name:TOMY STARCK MD PA
Other - Org Name:ULTRAVISION
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOMY
Authorized Official - Middle Name:
Authorized Official - Last Name:STARCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-308-5550
Mailing Address - Street 1:6818 HEUERMANN ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78256-9603
Mailing Address - Country:US
Mailing Address - Phone:210-308-5550
Mailing Address - Fax:210-308-6161
Practice Address - Street 1:6818 HEUERMANN ROAD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78256-9603
Practice Address - Country:US
Practice Address - Phone:210-308-5550
Practice Address - Fax:210-308-6161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5911207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00814TMedicare PIN
TXF91441Medicare UPIN