Individual
MARK D. ESAREY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1700 18TH ST, CHARLESTON, IL 61920-3607
(217) 345-6600
(217) 345-6622
Mailing address
1700 18TH ST, CHARLESTON, IL 61920-3607
(217) 345-6600
(217) 345-6622
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046008046
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548267099
—
IL
01
—
1584009
BCBS PROVIDER NUMBER
IL
01
—
371219488
DMERC SUPPLIER NUMBER
IL
01
—
410024492
TRAVELERS MEDICARE
IL
Enumeration date
06/30/2005
Last updated
02/24/2012
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