Provider Demographics
NPI:1740264837
Name:HESTER, MARK R (OD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:HESTER
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:3745 CHEROKEE ST NW
Mailing Address - Street 2:STE 404
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6733
Mailing Address - Country:US
Mailing Address - Phone:770-590-8191
Mailing Address - Fax:770-590-8192
Practice Address - Street 1:3745 CHEROKEE ST NW
Practice Address - Street 2:STE 404
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6733
Practice Address - Country:US
Practice Address - Phone:770-590-8191
Practice Address - Fax:770-590-8192
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-01
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GAGA1498152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU58089Medicare UPIN
GA41ZCDZWMedicare ID - Type Unspecified