Healthcare Provider Details

I. General information

NPI: 1003136466
Provider Name (Legal Business Name): M ANDREW DURANT OD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 01/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 MINI MALL DR
BEREA KY
40403-1170
US

IV. Provider business mailing address

1213 YORKSHIRE ESTATES RD
LONDON KY
40744-8309
US

V. Phone/Fax

Practice location:
  • Phone: 859-985-0078
  • Fax: 859-985-0045
Mailing address:
  • Phone: 859-985-0078
  • Fax: 859-985-0045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL DURANT
Title or Position: OWNER
Credential: O.D.
Phone: 606-682-3753