Daryn W Derstine OD PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

2773ATI Issued in OR

Legal business name

DARYN W DERSTINE OD PC

Practice address

12000 SE 82ND Ave
1008
Portland, OR 97266-7721

Phone

(503) 654-6217

Fax

(503) 654-9335

NPI assigned

Feb 20, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Daryn W Derstine, O.D.

Title

President

Phone

(503) 654-6217

Specialties & licenses 1

Addresses

Other names 1

• Master Eye Associates, SE Doing business as

Locations

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1285779140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12000 SE 82ND AVE",
            "address_2": "1008",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97086",
            "telephone_number": "503-654-6217",
            "fax_number": "503-654-9335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12000 SE 82ND AVE",
            "address_2": "1008",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972667721",
            "telephone_number": "503-654-6217",
            "fax_number": "503-654-9335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DARYN W DERSTINE OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DERSTINE",
        "authorized_official_first_name": "DARYN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-654-6217",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OR",
            "license": "2773ATI",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Master Eye Associates, SE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shaznin Daruwalla, PSY.D.
• Zanyar Darvishi Sr., DMD
• Hani Darwich, MD
• Ramzy Darwish, LCSW
• Spandana Lavanya Daryani
• Anjali Das, M.D
• Asish K. Das, MD
• Rohit R Das, MD MPH
• Chelsea Dascher
• Daseal Enterprises LLC

• Optometrist in Portland, OR
• Providers in Portland, OR by specialty
• Optometrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.