Donald Dean Derryberry Jr., O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4584TG Issued in TX

Practice address

18170 Dallas Pkwy
Suite 402
Dallas, TX 75287-7137

Phone

(972) 931-2020

NPI assigned

Jul 7, 2005

Last updated

Apr 20, 2009By 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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

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

Specialty

Optometry

Education

University of Houston - College of Optometry, 1991

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

Networks

• UT PPO D-SNP
• UT PPO

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.

• Advanced Eyecare Associates PC

  • Optometrist
  • Dallas, TX
  • NPI 1487870309
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1240185600000",
    "number": "1194722082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18170 DALLAS PKWY",
            "address_2": "SUITE 402",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752877137",
            "telephone_number": "972-931-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18170 DALLAS PKWY",
            "address_2": "SUITE 402",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752877137",
            "telephone_number": "972-931-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERRYBERRY",
        "first_name": "DONALD",
        "middle_name": "DEAN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2009-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "4584TG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN INDIVIDUAL",
            "identifier": "8F21032",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nathan Glen Deron Jr., DO
• Shayla Derousseau, M.D.
• David Brian Derr, PH.D.
• Latasha Deshea Derrick-Feyisetan, LMSW
• Howard C. Derrick III, M.D.
• Jeff Dersh, PH.D.
• Kailey Derting, LPC-A
• Des Peres Physician Network, LLC
• Aalaap Desai, MD
• Amit P Desai, M.D.

• Optometrist in Dallas, TX
• Providers in Dallas, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2009; 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.