Healthcare Provider Details

I. General information

NPI: 1508886078
Provider Name (Legal Business Name): DARCY L DUZAN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 18TH ST
CHARLESTON IL
61920-3607
US

IV. Provider business mailing address

1700 18TH ST
CHARLESTON IL
61920-3607
US

V. Phone/Fax

Practice location:
  • Phone: 217-345-6600
  • Fax: 217-345-6622
Mailing address:
  • Phone: 217-345-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046009869
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: