NPIMap

Organization Active NPI

Derry Family Eyecare LLC

Doing business as Richardson Eye Clinic

  • Optometrist
  • Vancouver, WA
National Provider Identifier
1396459616
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
DERRY FAMILY EYECARE LLC
Doing business as
Richardson Eye Clinic
Practice address
12116 SE Mill Plain Blvd
Suite 1
Vancouver, WA 98684
Phone
(360) 892-3828
Fax
(360) 254-0576
NPI assigned
Jan 11, 2023
Last updated
Nov 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Authorized official

Name
Mrs. Kristen Elaine Derry, ODNPI 1730523788
Title
Optometrist
Phone
(360) 892-3828

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X Primary

Addresses

Primary practice location

12116 SE Mill Plain Blvd
Suite 1
Vancouver, WA 98684

Mailing address

12116 SE Mill Plain Blvd
Suite 1
Vancouver, WA 98684
Phone (360) 892-3828

Other names 1

  • Richardson Eye Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221221001969 WA Part B Supplier - Clinic/Group Practice 9638549371 Receives reassigned benefits from 1 practitioner
Practice locations: Vancouver, WA

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://app.meldrx.com/api/fhir/90yt21gf

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1673395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1396459616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12116 SE MILL PLAIN BLVD",
            "address_2": "SUITE 1",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "98684",
            "telephone_number": "360-892-3828",
            "fax_number": "360-254-0576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12116 SE MILL PLAIN BLVD",
            "address_2": "SUITE 1",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "98684",
            "telephone_number": "360-892-3828",
            "fax_number": "360-254-0576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERRY FAMILY EYECARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-11",
        "last_updated": "2023-11-27",
        "certification_date": "2023-11-27",
        "status": "A",
        "authorized_official_last_name": "DERRY",
        "authorized_official_first_name": "KRISTEN",
        "authorized_official_middle_name": "ELAINE",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "360-892-3828",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Richardson Eye Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Richardson Eye Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.