1427137348 NPI number — DURAND OPTOMETRY CLINIC LLC

Table of content: (NPI 1427137348)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427137348 NPI number — DURAND OPTOMETRY CLINIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DURAND OPTOMETRY CLINIC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427137348
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 E. MAIN ST.
Provider Second Line Business Mailing Address:
P.O. BOX 147
Provider Business Mailing Address City Name:
DURAND
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54736-0147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-672-8981
Provider Business Mailing Address Fax Number:
715-672-8983

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURAND
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-672-8981
Provider Business Practice Location Address Fax Number:
715-672-8983
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MORRIS
Authorized Official First Name:
TONY
Authorized Official Middle Name:
RAYMOND
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
715-672-8981

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2689 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 23193 . This is a "NVA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2100386 . This is a "MEDICA-MATERIALS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 59158DU . This is a "BCBS OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 115291 . This is a "HEALTHPARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 220856 . This is a "MEDICA-EXAM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2210848 . This is a "SELECT CARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 38429700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 45862 . This is a "SPECTRA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5681910001 . This is a "DMERC" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: A65371016545 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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