Healthcare Provider Details

I. General information

NPI: 1629029400
Provider Name (Legal Business Name): MICHAEL ANDREW DURANT O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2006
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

116 MINI MALL DR
BEREA KY
40403-1170
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 Number1345DT
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: