Provider Demographics
NPI:1508886078
Name:DUZAN, DARCY L (OD)
Entity Type:Individual
Prefix:
First Name:DARCY
Middle Name:L
Last Name:DUZAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 18TH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-3607
Mailing Address - Country:US
Mailing Address - Phone:217-345-6600
Mailing Address - Fax:
Practice Address - Street 1:1700 18TH ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-3607
Practice Address - Country:US
Practice Address - Phone:217-345-6600
Practice Address - Fax:217-345-6622
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009869152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1584009OtherBCBS PROVIDER NUMBER
ILP00374913OtherRAILROAD MEDICARE
IL1508886078Medicaid
IL371219488OtherDMERC SUPPLIER #
IL214236Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
IL1584009OtherBCBS PROVIDER NUMBER
IL371219488OtherDMERC SUPPLIER #