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General NPI Number Information
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NPI Number | 1427137348
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Entity Type | Organization
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Legal Business Name | DURAND OPTOMETRY CLINIC LLC
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 06/01/2018
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Provider Practice Location Address
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Address Line | 100 E MAIN ST
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City | DURAND
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State | WI
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Zip | 54736
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Country | US
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Telephone | 715-672-8981
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Fax | 715-672-8983
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Provider Business Mailing Address
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Address Line | 100 E. MAIN ST. P.O. BOX 147
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City | DURAND
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State | WI
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Zip | 54736-0147
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Country | US
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Telephone | 715-672-8981
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Fax | 715-672-8983
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Authorized Official
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Title or Position | OWNER
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Name | DR. TONY RAYMOND MORRIS
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Credential | O.D.
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Telephone | 715-672-8981
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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 | 2689
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License Number State | WI
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