Provider Demographics
NPI:1285847509
Name:DAVID E. DURYEA, O.D., P.C
Entity Type:Organization
Organization Name:DAVID E. DURYEA, O.D., P.C
Other - Org Name:ADVANCED EYECARE & CONTACT LENS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
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:989-845-7050
Mailing Address - Street 1:1555 BRADY ROAD
Mailing Address - Street 2:
Mailing Address - City:CHESANING
Mailing Address - State:MI
Mailing Address - Zip Code:48616
Mailing Address - Country:US
Mailing Address - Phone:989-845-7050
Mailing Address - Fax:989-845-2036
Practice Address - Street 1:1555 BRADY ROAD
Practice Address - Street 2:
Practice Address - City:CHESANING
Practice Address - State:MI
Practice Address - Zip Code:48616
Practice Address - Country:US
Practice Address - Phone:989-845-7050
Practice Address - Fax:989-845-2036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI94505795Medicaid
MI944316613Medicaid
MIV07174Medicare UPIN
MIU82023Medicare UPIN
MI94505795Medicaid
MI944316613Medicaid
MIN17900004Medicare ID - Type UnspecifiedDR. WICKE
MIN17900002Medicare ID - Type UnspecifiedDR. BILLY