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NPI Code Detail

MEDICARE: DAVID E. DURYEA, O.D., P.C.

MEDICARE: DAVID E. DURYEA, O.D., P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist4901002587MI

General Provider Information

NPI Number : 1053380865
Entity Type Code : Organization
Provider Name (Legal Business Name) : DAVID E. DURYEA, O.D., P.C.
Provider Business Mailing Address
First Line : 123 S SAGINAW ST
Second Line :
City : SAINT CHARLES
State : MI
Zip : 48655-1403
Country : US
Telephone Number : 989-865-9979
Fax Number : 989-865-6686
Provider Business Practice Location Address
First Line : 123 S SAGINAW ST
Second Line :
City : SAINT CHARLES
State : MI
Zip : 48655-1403
Country : US
Telephone Number : 989-865-9979
Fax Number : 989-865-6686
Authorized Official
Title or Position : PRESIDENT
Name : DR. DAVID ERIC DURYEA
Credential : O.D.
Telephone Number : 989-865-9979
Provider Enumeration Date : 03/15/2006
Last Update Date : 08/19/2009

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Directions to “DAVID E. DURYEA, O.D., P.C. ” Practice Location

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