Provider Demographics
NPI:1386721314
Name:SAUNDERS, J. MARK (OD)
Entity type:Individual
Prefix:
First Name:J. MARK
Middle Name:
Last Name:SAUNDERS
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 1:4637 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28470-4453
Mailing Address - Country:US
Mailing Address - Phone:910-754-9687
Mailing Address - Fax:910-755-9891
Practice Address - Street 1:4637 MAIN ST
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-4453
Practice Address - Country:US
Practice Address - Phone:910-754-9687
Practice Address - Fax:910-755-9891
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1373152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist