Provider Demographics
NPI:1679542633
Name:DURYEA, DAVID ERIC (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ERIC
Last Name:DURYEA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 BRADY ROAD
Mailing Address - Street 2:
Mailing Address - City:CHESANING
Mailing Address - State:MI
Mailing Address - Zip Code:48616-0355
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:48616-0355
Practice Address - Country:US
Practice Address - Phone:989-845-7050
Practice Address - Fax:989-845-2036
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002587152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI94505795Medicaid
MI94505795Medicaid
MI0199800001Medicare NSC
MIT33562Medicare UPIN