Provider Demographics
NPI:1831448364
Name:WESOLOSKI, MARK II (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:WESOLOSKI
Suffix:II
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 1:35 SUTTLES RD STE 140
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-5531
Mailing Address - Country:US
Mailing Address - Phone:919-542-8439
Mailing Address - Fax:
Practice Address - Street 1:35 SUTTLES RD STE 140
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312-5531
Practice Address - Country:US
Practice Address - Phone:919-542-8439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2306152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist