Provider Demographics
NPI:1205962347
Name:SCHONING, MARK ALLEN (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLEN
Last Name:SCHONING
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 1:5501 CAPITAL BLVD
Mailing Address - Street 2:STE 104B
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-1971
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1309 NW MAYNARD RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8722
Practice Address - Country:US
Practice Address - Phone:919-460-7470
Practice Address - Fax:919-467-5118
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1342152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890969CMedicaid
NC890936NMedicaid
NC2467117BMedicare ID - Type UnspecifiedGROUP
NC890969CMedicaid