Provider Demographics
NPI:1215372065
Name:RENDON, ZOPHIA (OD)
Entity Type:Individual
Prefix:DR
First Name:ZOPHIA
Middle Name:
Last Name:RENDON
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 1:316 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-4402
Mailing Address - Country:US
Mailing Address - Phone:336-667-6782
Mailing Address - Fax:336-667-7968
Practice Address - Street 1:316 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-4402
Practice Address - Country:US
Practice Address - Phone:336-667-6782
Practice Address - Fax:336-667-7968
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2348152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1215372065Medicaid
NCNCL647AMedicare PIN