Provider Demographics
NPI:1427430594
Name:STARCHVILLE, JONATHAN MICHAEL (OD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:MICHAEL
Last Name:STARCHVILLE
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 1:2301 S HAMPTON RD STE 500
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-1654
Mailing Address - Country:US
Mailing Address - Phone:214-330-3937
Mailing Address - Fax:214-330-3939
Practice Address - Street 1:2301 S HAMPTON RD STE 500
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-1654
Practice Address - Country:US
Practice Address - Phone:214-330-3937
Practice Address - Fax:214-330-3939
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8708TG152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3488587Medicaid