Provider Demographics
NPI:1942446588
Name:MARK R SUKOENIG OD PC
Entity Type:Organization
Organization Name:MARK R SUKOENIG OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:SUKOENIG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:315-698-0033
Mailing Address - Street 1:8112 BREWERTON RD
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-9586
Mailing Address - Country:US
Mailing Address - Phone:315-698-0033
Mailing Address - Fax:315-699-0855
Practice Address - Street 1:8112 BREWERTON RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-9586
Practice Address - Country:US
Practice Address - Phone:315-698-0033
Practice Address - Fax:315-699-0855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-04
Last Update Date:2009-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTU003680-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty