Provider Demographics
NPI:1871238493
Name:EYES ON NORTH RIDGE OD, PLLC
Entity Type:Organization
Organization Name:EYES ON NORTH RIDGE OD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:VIDACIC
Authorized Official - Last Name:MOKRIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-592-4512
Mailing Address - Street 1:6136 FALLS OF NEUSE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-3528
Mailing Address - Country:US
Mailing Address - Phone:842-066-8909
Mailing Address - Fax:984-307-0115
Practice Address - Street 1:6136 FALLS OF NEUSE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-3528
Practice Address - Country:US
Practice Address - Phone:702-592-4512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-28
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty