Provider Demographics
NPI:1467889881
Name:PHEBUS, MARK R (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:PHEBUS
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 1:843 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3222
Mailing Address - Country:US
Mailing Address - Phone:704-878-2660
Mailing Address - Fax:
Practice Address - Street 1:843 N CENTER ST
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3222
Practice Address - Country:US
Practice Address - Phone:704-878-2660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2419152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist