Individual
DR. JEREMY M. DURHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
437 N TYLER RD, WICHITA, KS 67212-3630
(316) 722-1001
(316) 722-1073
Mailing address
437 N TYLER RD, WICHITA, KS 67212-3630
(316) 722-1001
(316) 722-1073
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1651
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0803320001
DMERC
KS
05
—
200333580A
—
KS
01
—
650938
BLUE CROSS
KS
Enumeration date
10/07/2005
Last updated
08/11/2011
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