Provider Demographics
NPI:1841587052
Name:DURIAS, AUTUMN BLAIRE M (OD)
Entity Type:Individual
Prefix:DR
First Name:AUTUMN BLAIRE
Middle Name:M
Last Name:DURIAS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3001 S MICHIGAN AVE
Mailing Address - Street 2:UNIT 308
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-3261
Mailing Address - Country:US
Mailing Address - Phone:630-400-7305
Mailing Address - Fax:
Practice Address - Street 1:102 STRATFORD SQUARE MALL
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2202
Practice Address - Country:US
Practice Address - Phone:630-893-7688
Practice Address - Fax:630-893-0420
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL000000000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist