Provider Demographics
NPI:1235286360
Name:OSBORNE, SONJA ANN (OPTICIAN)
Entity Type:Individual
Prefix:MRS
First Name:SONJA
Middle Name:ANN
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5676 BUCKHORN RD
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-9627
Mailing Address - Country:US
Mailing Address - Phone:336-766-2026
Mailing Address - Fax:336-760-4240
Practice Address - Street 1:3320 SILAS CREEK PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3031
Practice Address - Country:US
Practice Address - Phone:336-760-4240
Practice Address - Fax:336-760-4240
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC471156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8802014Medicaid
NC4709790001Medicare ID - Type Unspecified