Provider Demographics
NPI:1053640540
Name:ESAKA, AGNES FORSAC (OD)
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:FORSAC
Last Name:ESAKA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208A KIRKWOOD HWY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-6130
Mailing Address - Country:US
Mailing Address - Phone:302-397-8515
Mailing Address - Fax:302-397-8685
Practice Address - Street 1:3208A KIRKWOOD HWY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-6130
Practice Address - Country:US
Practice Address - Phone:302-397-8515
Practice Address - Fax:302-397-8685
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002293152W00000X
DE130001334152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist