Provider Demographics
NPI:1285319889
Name:DURESA, ERIC (OD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:DURESA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9916 75TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-7583
Mailing Address - Country:US
Mailing Address - Phone:262-637-0500
Mailing Address - Fax:262-635-8027
Practice Address - Street 1:13200 GLOBE DR STE 216
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53177-1605
Practice Address - Country:US
Practice Address - Phone:262-637-0500
Practice Address - Fax:262-635-8027
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3924-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist