Provider Demographics
NPI:1598068991
Name:PRESTON H. STARKS FAMILY EYECARE LLC
Entity Type:Organization
Organization Name:PRESTON H. STARKS FAMILY EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PRESTON
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:STARKS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-564-4177
Mailing Address - Street 1:2641 LANTANA LAKES CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-4634
Mailing Address - Country:US
Mailing Address - Phone:904-564-4177
Mailing Address - Fax:904-641-8072
Practice Address - Street 1:12100 LEM TURNER RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-2304
Practice Address - Country:US
Practice Address - Phone:904-564-4177
Practice Address - Fax:904-641-8072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 2779152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty