Provider Demographics
NPI:1730170929
Name:LESTER, MARC W (OD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:W
Last Name:LESTER
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:67 MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-5204
Mailing Address - Country:US
Mailing Address - Phone:415-389-6311
Mailing Address - Fax:
Practice Address - Street 1:44 MONTGOMERY ST
Practice Address - Street 2:SUITE 2020
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-4602
Practice Address - Country:US
Practice Address - Phone:415-392-1068
Practice Address - Fax:415-788-4019
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA7835 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U75312Medicare UPIN