Provider Demographics
NPI:1427073410
Name:CLONINGER, DONAVON R JR (OD)
Entity type:Individual
Prefix:DR
First Name:DONAVON
Middle Name:R
Last Name:CLONINGER
Suffix:JR
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 1:720 SE MAYNARD RD
Mailing Address - Street 2:BARNES & NOBLE PLAZA
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-5720
Mailing Address - Country:US
Mailing Address - Phone:919-467-0959
Mailing Address - Fax:919-467-5939
Practice Address - Street 1:720 SE MAYNARD RD
Practice Address - Street 2:BARNES & NOBLE PLAZA
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-5720
Practice Address - Country:US
Practice Address - Phone:919-467-0959
Practice Address - Fax:919-467-5939
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC994152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09161OtherBCBSNC PROVIDER ID
NC246358DMedicare PIN
NCT64898Medicare UPIN