Provider Demographics
NPI:1124485503
Name:MOKRIS, SANDRA VIDACIC (OD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:VIDACIC
Last Name:MOKRIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:VIDACIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
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:984-206-6890
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:984-206-6890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-15
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2541152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist