Provider Demographics
NPI:1053380865
Name:DAVID E. DURYEA, O.D., P.C.
Entity type:Organization
Organization Name:DAVID E. DURYEA, O.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:DURYEA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:989-865-9979
Mailing Address - Street 1:123 S SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MI
Mailing Address - Zip Code:48655-1403
Mailing Address - Country:US
Mailing Address - Phone:989-865-9979
Mailing Address - Fax:989-865-6686
Practice Address - Street 1:123 S SAGINAW ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MI
Practice Address - Zip Code:48655-1403
Practice Address - Country:US
Practice Address - Phone:989-865-9979
Practice Address - Fax:989-865-6686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002587152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION17900Medicare ID - Type Unspecified