Provider Demographics
NPI:1568685717
Name:DURBAN, MONEERA M (OD)
Entity Type:Individual
Prefix:
First Name:MONEERA
Middle Name:M
Last Name:DURBAN
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 1:217 BOBBY JONES EXPY
Mailing Address - Street 2:SUITE B
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-5255
Mailing Address - Country:US
Mailing Address - Phone:706-860-1171
Mailing Address - Fax:706-860-1841
Practice Address - Street 1:217 BOBBY JONES EXPY
Practice Address - Street 2:SUITE B
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-5255
Practice Address - Country:US
Practice Address - Phone:706-860-1171
Practice Address - Fax:706-860-1841
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2351152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA499937484BMedicaid
GA499937484AMedicaid