Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FX1100X | Ophthalmic | G85398 | CA |
Y | 207W00000X | Ophthalmologist | G85398 | CA |
NPI | 1124150065 |
---|---|
Provider Name | Dr. Tara Starr |
First Address | Lafayette, CA 94549 |
Second Address | Berkeley, CA 94705-2018 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 21/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G853980 | (05) | CA |
H53722 | (02) | CA |