Provider Demographics
NPI:1528265691
Name:DURANT EYE CARE
Entity type:Organization
Organization Name:DURANT EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:DWAYNE
Authorized Official - Last Name:DURANT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-554-2020
Mailing Address - Street 1:300 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30830-1511
Mailing Address - Country:US
Mailing Address - Phone:706-554-2020
Mailing Address - Fax:706-554-2020
Practice Address - Street 1:300 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:GA
Practice Address - Zip Code:30830-1511
Practice Address - Country:US
Practice Address - Phone:706-554-2020
Practice Address - Fax:706-554-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-01
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1273-T152W00000X
GA1272-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00515193DMedicaid
GAU25482Medicare UPIN
GAU28357Medicare UPIN
GA41ZCBVMMedicare ID - Type Unspecified
GAGRP1625Medicare PIN
GA41ZCCHPMedicare ID - Type Unspecified