Paul W Derrick, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

496 Issued in SC

Practice address

7229 St Andrews Road
Irmo, SC 29063-0722

Phone

(803) 781-2212

Fax

(803) 233-2883

NPI assigned

Mar 24, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

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 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Branch & Stafford Optometric Associates, PA

  • Optometrist
  • Chapin, SC
  • NPI 1134290869
  NPD (past)
• Branch & Stafford Optometric Associates, PA

  • Optometrist
  • Newberry, SC
  • NPI 1194895805
  NPD (past)
• Branch & Stafford Optometric Associates, PA

  • Optometrist
  • Columbia, SC
  • NPI 1235218496
  NPD (past)
• Shoes Etc LLC

  • Durable Medical Equipment & Medical Supplies
  • Columbia, SC
  • NPI 1144205766
  NPD (past)

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

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512691200000",
    "number": "1083674113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 BEACHWOOD W",
            "city": "ISLE OF PALMS",
            "state": "SC",
            "postal_code": "294512899",
            "telephone_number": "803-781-2212",
            "fax_number": "803-233-2883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7229 ST ANDREWS ROAD",
            "city": "IRMO",
            "state": "SC",
            "postal_code": "290630722",
            "telephone_number": "803-781-2212",
            "fax_number": "803-233-2883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERRICK",
        "first_name": "PAUL",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-24",
        "last_updated": "2017-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "496",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D04966",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Olivia Dean
• Michael David Deason, LPC
• Seneca Decastro, OPTICIAN
• Deborah Mullins Dellinger, LPC
• Steven Denton, PTA
• Genea Deshields Deshields Boykin, MSP CCC SLP
• John Dickinson
• Heather Diebold, PHARMD
• Shannon Dill-Williams, MSW
• Joanne Dimirra

• Optometrist in Irmo, SC
• Providers in Irmo, SC by specialty
• Optometrist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2017; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.