Individual
DR. LISA DURHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
54 THE LEGENDS PKWY STE 151, EUREKA, MO 63025-3803
(636) 938-7010
(636) 938-7141
Mailing address
40 E NORTH ST, EUREKA, MO 63025-1205
(636) 200-4393
(636) 938-2650
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2004017331
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
318454709
—
MO
05
—
318454717
—
MO
Enumeration date
06/23/2005
Last updated
11/18/2014
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