Provider Demographics
NPI:1033560974
Name:ESDERS, MARY (OD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:ESDERS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1221 S CREASY LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-7430
Mailing Address - Country:US
Mailing Address - Phone:765-447-4951
Mailing Address - Fax:765-447-4834
Practice Address - Street 1:1221 S CREASY LN
Practice Address - Street 2:SUITE A
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-7430
Practice Address - Country:US
Practice Address - Phone:765-447-4951
Practice Address - Fax:765-447-4834
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN18003968A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist