Durham, Jeremy M.

Durham, Jeremy M. is an individual health care provider with primary practice located at 437 N Tyler Rd , Wichita KS 67212-3630. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Durham, Jeremy M. can be contacted via phone (316) 722-1001.

Contact Information

Primary practice address
437 N Tyler Rd Wichita KS 67212-3630
Phone: (316) 722-1001
Fax: (316) 722-1073
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 1651 Kansas

Profile Details

NPI number 1750379368
LBN Legal business name Durham, Jeremy M.
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 7th, 2005
Last updated Aug 11th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750379368 NPPES
Kansas MEDICAID 200333580A
Kansas Other 650938
Kansas Other 0803320001

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