Provider Demographics
NPI:1699830554
Name:DURANT, BILL (OD)
Entity Type:Individual
Prefix:
First Name:BILL
Middle Name:
Last Name:DURANT
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 1:335 N ADAMS ST
Mailing Address - Street 2:#209
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-3820
Mailing Address - Country:US
Mailing Address - Phone:818-545-0606
Mailing Address - Fax:
Practice Address - Street 1:4518 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2913
Practice Address - Country:US
Practice Address - Phone:818-501-6474
Practice Address - Fax:818-788-6379
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8710152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP8710Medicare ID - Type Unspecified
CAU44548Medicare UPIN