Provider Demographics
NPI:1013178664
Name:ESBENSEN, GREGORY ALAN (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:ALAN
Last Name:ESBENSEN
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 N MARKET ST
Mailing Address - Street 2:WILMINGTON OPTICAL
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-3007
Mailing Address - Country:US
Mailing Address - Phone:302-654-0530
Mailing Address - Fax:302-654-7425
Practice Address - Street 1:616 N MARKET ST
Practice Address - Street 2:WILMINGTON OPTICAL
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-3007
Practice Address - Country:US
Practice Address - Phone:302-654-0530
Practice Address - Fax:302-654-7425
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician