Gerald R Starchvick, O.D.

Primary specialty

Corneal and Contact Management OptometristTaxonomy code 152WC0802X

License

1563T Issued in OR

Practice address

1251 E McAndrews Rd
Suite 100
Medford, OR 97504-6497

Phone

(541) 779-1392

Fax

(541) 779-6531

NPI assigned

Jun 20, 2005

Reactivated

Mar 28, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 6

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 1981

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Maisha Optical LLCGroup PAC ID 8628433091, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Maisha Optical LLC

  • Optometrist
  • Medford, OR
  • NPI 1013603380

  Corneal and Contact Management

  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1199923200000",
    "number": "1972508596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 POWDERHORN DR",
            "city": "JACKSONVILLE",
            "state": "OR",
            "postal_code": "975309420",
            "telephone_number": "541-779-1392",
            "fax_number": "541-779-6531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1251 E MCANDREWS RD",
            "address_2": "SUITE 100",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975046497",
            "telephone_number": "541-779-1392",
            "fax_number": "541-779-6531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STARCHVICK",
        "first_name": "GERALD",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-20",
        "last_updated": "2008-01-10",
        "deactivation_date": "2006-03-20",
        "reactivation_date": "2006-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "OR",
            "license": "1563T",
            "primary": true
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "OR",
            "license": "1563T",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "OR",
            "license": "1563T",
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "",
            "desc": "Optometrist, Sports Vision",
            "state": "OR",
            "license": "1563T",
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "OR",
            "license": "1563T",
            "primary": false
        },
        {
            "code": "152WX0102X",
            "taxonomy_group": "",
            "desc": "Optometrist, Occupational Vision",
            "state": "OR",
            "license": "1563T",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "212666",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119268",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kaitlin Eileen Stapleton, FNP
• Cassandra Lynn Stapp
• Star Dialysis LLC
• Star Dialysis LLC
• Starchvick Optical Inc
• Dawn E Starkey, CNA
• Kelsey Starley
• Matt Starley, DMD
• Broderick R States
• Linda S. Stead, LCSW

• Corneal and Contact Management Optometrist in Medford, OR
• Providers in Medford, OR by specialty
• Corneal and Contact Management Optometrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.