Healthcare Provider Details

I. General information

NPI: 1144417510
Provider Name (Legal Business Name): MARILYN ANN HESTER LDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 N ROXBORO ST
DURHAM NC
27704-2181
US

IV. Provider business mailing address

3901 N ROXBORO ST
DURHAM NC
27704-2181
US

V. Phone/Fax

Practice location:
  • Phone: 919-477-4006
  • Fax: 919-477-4006
Mailing address:
  • Phone: 919-477-4006
  • Fax: 919-477-4006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number1551
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: