Provider Demographics
NPI:1972641751
Name:STARCK, TOMY (MD)
Entity Type:Individual
Prefix:
First Name:TOMY
Middle Name:
Last Name:STARCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6818 HEUERMANN ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78256-9603
Mailing Address - Country:US
Mailing Address - Phone:210-308-5550
Mailing Address - Fax:210-308-6161
Practice Address - Street 1:6818 HEUERMANN ROAD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78256-9603
Practice Address - Country:US
Practice Address - Phone:210-308-5550
Practice Address - Fax:210-308-6161
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5911207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00814TMedicare ID - Type Unspecified
TXF91441Medicare UPIN