Provider Demographics
NPI:1588660567
Name:STARR, BRIAN L (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:L
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 1:58 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338-1213
Mailing Address - Country:US
Mailing Address - Phone:419-947-8330
Mailing Address - Fax:419-947-8355
Practice Address - Street 1:58 W HIGH ST
Practice Address - Street 2:
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-1213
Practice Address - Country:US
Practice Address - Phone:419-947-8330
Practice Address - Fax:419-947-8355
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3826 T-665152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0627101Medicaid
OH5274170001Medicare NSC
OHU20938Medicare UPIN
OHST0718194Medicare PIN