Derik Hardesty, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

AT4638 Issued in OR

Practice address

101 NW 12TH Ave Ste 101
Battle Ground, WA 98604-9145

Phone

(360) 687-0755

Fax

(360) 666-8664

NPI assigned

Apr 20, 2021

Last updated

Mar 6, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR, WA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Optometry

Education

Southern California College of Optometry, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Spec'D Out Eye Care, PS

  • Optometrist
  • Battle Ground, WA
  • NPI 1821896531
  Medicare reassignment NPD Authorized official
• Watters Vision Care Inc

  • Optometrist
  • Battle Ground, WA
  • NPI 1912235078
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1618876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741219200000",
    "number": "1003497058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 NW 12TH AVE STE 101",
            "city": "BATTLE GROUND",
            "state": "WA",
            "postal_code": "986049145",
            "telephone_number": "360-687-0755",
            "fax_number": "360-666-8664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 NW 12TH AVE STE 101",
            "city": "BATTLE GROUND",
            "state": "WA",
            "postal_code": "986049145",
            "telephone_number": "360-687-0755",
            "fax_number": "360-666-8664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARDESTY",
        "first_name": "DERIK",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-20",
        "last_updated": "2025-03-06",
        "certification_date": "2025-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "AT4638",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brad N Halleck, D.D.S
• Ellie Marie Hamilton
• Peggy Hanik, PT
• Lindsay Ann Hansen, LMFT
• Harder Development IV LLC (Mallard Landing Asst Living Community)
• Josie Chenille Hardy
• Sarah Harmon, PA-C
• Rashidah Hasan, MS CCC-SLP
• Healing Craniosacral & Physical Therapy, LLC
• Heart & Soul Housecall Providers, LLC

• Optometrist in Battle Ground, WA
• Providers in Battle Ground, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.