Provider Demographics
NPI:1124481676
Name:ROSTANKOVSKI, STAR (OD)
Entity type:Individual
Prefix:DR
First Name:STAR
Middle Name:
Last Name:ROSTANKOVSKI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-6304
Mailing Address - Country:US
Mailing Address - Phone:850-466-5355
Mailing Address - Fax:
Practice Address - Street 1:5100 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8735
Practice Address - Country:US
Practice Address - Phone:508-477-7646
Practice Address - Fax:850-476-9836
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5171152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017114100Medicaid
FLIN732ZMedicare PIN