Individual
DR. DEREK FREDERICK FATURA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
4854 W US HIGHWAY 10, LUDINGTON, MI 49431-8703
(231) 843-6553
Mailing address
6123 ALLIENE RD, LUDINGTON, MI 49431-9653
(231) 843-6640
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901004196
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
213230
COLE MANAGED VISION CIA#
MI
01
—
48638
DAVIS VISION ID#
MI
01
—
WALM19063
SPECTERA USER ID#
MI
Enumeration date
08/27/2006
Last updated
07/09/2007
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