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General NPI Number Information
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NPI Number | 1285319889
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Entity Type | Individual
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Provider Name | ERIC DURESA OD
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Gender | Male
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Dates
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Enumeration Date | 06/20/2023
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 13200 GLOBE DR STE 216
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City | MOUNT PLEASANT
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State | WI
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Zip | 53177-1605
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Country | US
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Telephone | 262-637-0500
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Fax | 262-635-8027
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Provider Business Mailing Address
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Address Line | 9916 75TH ST STE 101
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City | KENOSHA
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State | WI
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Zip | 53142-7583
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Country | US
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Telephone | 262-637-0500
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Fax | 262-635-8027
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3924-35
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License Number State | WI
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