Provider Demographics
NPI:1093774721
Name:CAVETT, SONJA (OD)
Entity Type:Individual
Prefix:DR
First Name:SONJA
Middle Name:
Last Name:CAVETT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 TERRELL RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-5567
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2911 TERRELL RD
Practice Address - Street 2:SUITE E
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-5567
Practice Address - Country:US
Practice Address - Phone:903-454-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6037TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5761920001Medicare NSC
TX1538254636Medicare NSC
TX00373PMedicare ID - Type Unspecified
TX00X190Medicare PIN