Provider Demographics
NPI:1922140052
Name:STAR OPTOMETRY ASSOCIATES LLC
Entity Type:Organization
Organization Name:STAR OPTOMETRY ASSOCIATES LLC
Other - Org Name:STAR EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:VEENHUIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:314-741-1111
Mailing Address - Street 1:11750 LUSHER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63138-1103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11750 LUSHER RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63138-1103
Practice Address - Country:US
Practice Address - Phone:314-741-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STAR OPTOMERTY ASSOCIATES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-13
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO 2896152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty