Individual
JEFFREY DAVID STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2472 BROADWAY, NEW YORK, NY 10025-7449
(212) 362-8090
(212) 875-1488
Mailing address
15 MOHEGAN PL, NEW ROCHELLE, NY 10804-1304
(914) 654-4967
(914) 654-4968
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV005062
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02324927
—
NY
Enumeration date
11/17/2006
Last updated
07/08/2007
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