Active NPI
Desiree Vanderstar
- Optometrist
- Memphis, TN
National Provider Identifier
1447779301
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 3417
- Practice address
- 1225 Madison Ave
Memphis, TN 38104-2211 - Phone
- (901) 722-3250
- NPI assigned
- Sep 12, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 3417 | TN | Primary |
Addresses
Primary practice location
1225 Madison Ave
Memphis, TN 38104-2211
Mailing address
1245 Madison Ave
Memphis, TN 38104-2211
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3417 | TN | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1505174400000",
"number": "1447779301",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1245 MADISON AVE",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381042211"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1225 MADISON AVE",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381042211",
"telephone_number": "901-722-3250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDERSTAR",
"first_name": "DESIREE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-09-12",
"last_updated": "2017-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "TN",
"license": "3417",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.