Provider Demographics
NPI:1619766516
Name:STARON, MICHAEL WALTER (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WALTER
Last Name:STARON
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 1:10620 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-2593
Mailing Address - Country:US
Mailing Address - Phone:708-769-1557
Mailing Address - Fax:
Practice Address - Street 1:10620 GRANDVIEW DR
Practice Address - Street 2:
Practice Address - City:PALOS PARK
Practice Address - State:IL
Practice Address - Zip Code:60464-2593
Practice Address - Country:US
Practice Address - Phone:708-769-1557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OHOPT.007365152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program