Provider Demographics
NPI:1306605324
Name:MAKITAN, SONJA (OD)
Entity type:Individual
Prefix:
First Name:SONJA
Middle Name:
Last Name:MAKITAN
Suffix:
Gender:F
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:PO BOX 2349
Mailing Address - Street 2:
Mailing Address - City:KING
Mailing Address - State:NC
Mailing Address - Zip Code:27021-2349
Mailing Address - Country:US
Mailing Address - Phone:336-296-0012
Mailing Address - Fax:336-642-5661
Practice Address - Street 1:141 SPRUCE PINE WAY STE C
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021-8445
Practice Address - Country:US
Practice Address - Phone:336-409-9122
Practice Address - Fax:336-642-5661
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2788152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist