Provider Demographics
NPI:1285733717
Name:STAARMANN FAMILY VISION CENTER, INC
Entity type:Organization
Organization Name:STAARMANN FAMILY VISION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR MICHELLE STAARMANN OD PRES
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:STAARMANN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:513-874-1718
Mailing Address - Street 1:2834 MACK ROAD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014
Mailing Address - Country:US
Mailing Address - Phone:513-874-1718
Mailing Address - Fax:513-870-5600
Practice Address - Street 1:2834 MACK ROAD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014
Practice Address - Country:US
Practice Address - Phone:513-874-1718
Practice Address - Fax:513-870-5600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3895152W00000X
OH3825152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0612941Medicare ID - Type Unspecified
T48767Medicare UPIN
OH0632940001Medicare NSC
OH9926491Medicare PIN