Provider Demographics
NPI:1972508596
Name:STARCHVICK, GERALD R (OD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:R
Last Name:STARCHVICK
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 1:600 POWDERHORN DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97530-9420
Mailing Address - Country:US
Mailing Address - Phone:541-779-1392
Mailing Address - Fax:541-779-6531
Practice Address - Street 1:1251 E MCANDREWS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6497
Practice Address - Country:US
Practice Address - Phone:541-779-1392
Practice Address - Fax:541-779-6531
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2008-01-10
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
OR1563T152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR212666OtherEYEMED
OR119268Medicaid
ORR111687Medicare ID - Type Unspecified
OR4352280001Medicare NSC
OR111689Medicare UPIN
OR119268Medicaid