Deshon, Clark Edward
Deshon, Clark Edward is an sole proprietor health care provider with primary practice located at 303 E Main St , Olney IL 62450. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Deshon, Clark Edward can be contacted via phone (618) 395-2676.Contact Information
Primary practice address
303 E Main St
Olney IL 62450
Phone: (618) 395-2676
Fax: (618) 395-2720
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 046008793 | Illinois |
Profile Details
| NPI number | 1861482309 |
|---|---|
| LBN Legal business name | Deshon, Clark Edward |
| Credentials | O.D., F.A.A.O |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 26th, 2005 |
| Last updated | Aug 31st, 2018 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1861482309 | NPPES |
| Illinois | Other | 5290131 | AETNA |
| Illinois | MEDICAID | 046008793 | AETNA |
| Illinois | Other | 09327152 | AETNA |
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