NPIMap

Organization Active NPI

Paul W Derrick, OD PA

  • Optometrist
  • North Charleston, SC
National Provider Identifier
1447693551
Registry record updated Apr 9, 2013
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Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
496 Issued in SC
Legal business name
PAUL W DERRICK, OD PA
Practice address
8096 Rivers Ave Ste a
North Charleston, SC 29406-9243
Phone
(843) 818-2020
Fax
(843) 818-2379
NPI assigned
Apr 9, 2013
Last updated
Apr 9, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2013

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

Authorized official

Name
Paul W Derrick, OD
Title
Owner
Phone
(843) 818-2020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 496 SC Primary

Addresses

Primary practice location

8096 Rivers Ave Ste a
North Charleston, SC 29406-9243

Mailing address

8096 Rivers Ave Ste a
North Charleston, SC 29406-9243
Phone (843) 818-2020

Other identifiers 1

IdentifierTypeStateIssuer
D04966MedicaidSC

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1365465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365465600000",
    "number": "1447693551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8096 RIVERS AVE STE A",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069243",
            "telephone_number": "843-818-2020",
            "fax_number": "843-818-2379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8096 RIVERS AVE STE A",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069243",
            "telephone_number": "843-818-2020",
            "fax_number": "843-818-2379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAUL W DERRICK, OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-09",
        "last_updated": "2013-04-09",
        "status": "A",
        "authorized_official_last_name": "DERRICK",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-818-2020",
        "authorized_official_credential": "OD"
    },
    "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": []
}

Other providers in North Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2013; 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.