Provider Demographics
NPI:1295731214
Name:SALOPEK, MARK D (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:SALOPEK
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 1:1920 EYRIE CT
Mailing Address - Street 2:APT 201
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-4745
Mailing Address - Country:US
Mailing Address - Phone:919-889-4438
Mailing Address - Fax:
Practice Address - Street 1:4170 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-3606
Practice Address - Country:US
Practice Address - Phone:919-772-2020
Practice Address - Fax:919-772-8818
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1511152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89093R4Medicaid
NCP00245416OtherRR MEDICARE
NC093R4OtherBCBS PIN
NC2473460Medicare ID - Type Unspecified
NCP00245416OtherRR MEDICARE