Derek Alan Black, O.D.
Individual provider Active NPI Optometrist · Cumming, GA
NPI 1114353232 · NPPES record last updated Oct 26, 2020
Key facts
- NPI
- 1114353232
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- OPT002922 (GA)
- Practice address
- 1211 Bald Ridge Marina Rd
Cumming, GA 30041-8484 - Phone
- (470) 239-6625
- Fax
- (470) 239-6626
- NPI assigned
- Sep 20, 2013
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Southern College of Optometry, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Lake Lanier Eye Care, LLC
Practice addresses (Care Compare)
5885 Cumming Hwy
Suite 401
Sugar Hill, GA 30518-5625
Phone (678) 926-3525
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160627001622 | GA | Practitioner - Optometry | 9133410848 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OPT002922 | GA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eagle View Eye Care, LLC | Optometrist | Current |
Accepting new patients |
Locations
1211 Bald Ridge Marina Rd
Cumming, GA 30041
Phone (470) 239-6620
4008 Mundy Mill Rd
Oakwood, GA 30566
Phone (770) 534-5305
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPT002922 | GA | Yes |
Addresses
Primary practice location
1211 Bald Ridge Marina Rd
Cumming, GA 30041-8484
Mailing address
1211 Bald Ridge Marina Rd
Cumming, GA 30041-8484
Phone (470) 239-6625
Other practice location 1
9300 DeWitt Loop
Ft Belvoir Community Hospital
Fort Belvoir, VA 22060-5285
Phone (571) 231-1431
Other providers in Cumming, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 26, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.