Healthcare Provider Details

I. General information

NPI: 1699607937
Provider Name (Legal Business Name): KAITLYN ANNE DURAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 W 4TH ST APT 206
BLOOMINGTON IN
47404-5172
US

IV. Provider business mailing address

314 W 4TH ST APT 206
BLOOMINGTON IN
47404-5172
US

V. Phone/Fax

Practice location:
  • Phone: 231-373-6776
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.0004205
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18004662A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: