Provider Demographics
NPI:1114258639
Name:DOUGLAS A. DUERSTOCK O.D. INC.
Entity Type:Organization
Organization Name:DOUGLAS A. DUERSTOCK O.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUERSTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-273-6901
Mailing Address - Street 1:567 IVY TECH DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-1802
Mailing Address - Country:US
Mailing Address - Phone:812-273-6901
Mailing Address - Fax:812-265-3275
Practice Address - Street 1:567 IVY TECH DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-1802
Practice Address - Country:US
Practice Address - Phone:812-273-6901
Practice Address - Fax:812-265-3275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002570B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty