Provider Demographics
NPI:1609071323
Name:ROBERT G. STARR M.D., INC
Entity Type:Organization
Organization Name:ROBERT G. STARR M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:GIGUERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-558-8488
Mailing Address - Street 1:7677 CENTER AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-9102
Mailing Address - Country:US
Mailing Address - Phone:858-558-8488
Mailing Address - Fax:858-558-1537
Practice Address - Street 1:7677 CENTER AVE STE 204
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-9102
Practice Address - Country:US
Practice Address - Phone:858-558-8488
Practice Address - Fax:858-558-1537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78105207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00180222OtherMEDICARE
CA00A781051Medicaid
CAP00180222OtherMEDICARE