Provider Demographics
NPI:1699743781
Name:SIKES, MARK MOSELEY (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:MOSELEY
Last Name:SIKES
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:PO BOX 60160
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0160
Mailing Address - Country:US
Mailing Address - Phone:704-365-0555
Mailing Address - Fax:704-367-8122
Practice Address - Street 1:135 S SHARON AMITY RD STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-3870
Practice Address - Country:US
Practice Address - Phone:704-365-0555
Practice Address - Fax:704-367-8120
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC1126152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09072OtherBCBS
NC4346985OtherAETNA
NC75512OtherMEDCOST
NC006OtherTRICARE FOR LIFE
NC8909072Medicaid
NC175004OtherCOVENTRY HEALTHCARE
NC338232OtherMAMSI
NC8758481003OtherCIGNA
NC2241545OtherUNITED HEALTHCARE
990010510OtherRAILROAD MEDICARE
NC8758481004OtherCIGNA
SC20096082OtherSELECT HEALTH OF SC
NC25145OtherKANAWHA
SCD0N126Medicaid
SC20096082OtherSELECT HEALTH OF SC
NC8909072Medicaid
NC0264730010Medicare NSC