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Contact Information

CLARK E DESHON, O.D., F.A.A.O
303 E MAIN ST
OLNEY, IL62450
 Phone: 618-395-2676
 Fax: 618-395-2720
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for CLARK E DESHON · (Male)

NPI Number 1861482309
Status Active
Credentials O.D., F.A.A.O
Entity Individual
Enumeration date 10/26/2005
Last updated 08/31/2018 - About 8 years ago
Sole proprietor 1 Yes
Identifiers
  • IL License # 046008793
  • IL Medicaid 046008793
  • IL Other 5290131 AETNA
  • IL Other 09327152 BLUE CROSS BLUE SHIELD
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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