Provider Demographics
NPI:1629464037
Name:STAR CITY EYE CARE
Entity Type:Organization
Organization Name:STAR CITY EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:MANUGUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-657-9602
Mailing Address - Street 1:4822 VALLEY VIEW BLVD NW
Mailing Address - Street 2:STE C
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-2025
Mailing Address - Country:US
Mailing Address - Phone:614-657-9602
Mailing Address - Fax:
Practice Address - Street 1:4822 VALLEY VIEW BLVD NW
Practice Address - Street 2:STE C
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-2025
Practice Address - Country:US
Practice Address - Phone:614-657-9602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty