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General NPI Number Information
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NPI Number | 1225224595
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Entity Type | Organization
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Legal Business Name | SOUTHERN OPTOMETRY GROUP
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Dates
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Enumeration Date | 09/20/2007
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Last Update Date | 03/18/2014
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Provider Practice Location Address
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Address Line | 10050 GLENWOOD AVE
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City | RALEIGH
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State | NC
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Zip | 27617-8436
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Country | US
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Telephone | 919-596-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 7724 BERRY CREST AVE
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City | RALEIGH
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State | NC
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Zip | 27617-8326
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Country | US
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Telephone | 919-596-3300
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK ALLEN SCHONING
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Credential | OD
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Telephone | 919-460-7470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1342
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License Number State | NC
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