Provider Demographics
NPI:1225186752
Name:MESTEY-ANSON, DANA L (OD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:L
Last Name:MESTEY-ANSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:L
Other - Last Name:MESTEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1520 SPRING HILL MALL
Mailing Address - Street 2:
Mailing Address - City:WEST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-1266
Mailing Address - Country:US
Mailing Address - Phone:847-426-4624
Mailing Address - Fax:847-426-5334
Practice Address - Street 1:1444 SPRING HILL MALL
Practice Address - Street 2:
Practice Address - City:WEST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-1264
Practice Address - Country:US
Practice Address - Phone:847-426-3198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU79950Medicare UPIN
ILL77843Medicare ID - Type Unspecified