Advanced Eyecare Associates PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

4584TG Issued in TX

Legal business name

ADVANCED EYECARE ASSOCIATES PC

Practice address

18170 Dallas Pkwy
Suite 402
Dallas, TX 75287-7137

Phone

(972) 931-2020

NPI assigned

Apr 18, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Donald D Derryberry Jr., O.D.NPI 1194722082

Title

Owner

Phone

(972) 931-2020

Specialties & licenses 4

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Donald Dean Derryberry Jr., O.D.

  • Optometrist
  • Dallas, TX
  • NPI 1194722082
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240185600000",
    "number": "1487870309",
    "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",
            "fax_number": "972-407-9452"
        },
        {
            "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": {
        "organization_name": "ADVANCED EYECARE ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2009-04-20",
        "status": "A",
        "authorized_official_last_name": "DERRYBERRY",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-931-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "TX",
            "license": "4584TG",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "TX",
            "license": "4584TG",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Pediatrics",
            "state": "TX",
            "license": "4584TG",
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Sports Vision",
            "state": "TX",
            "license": "4584TG",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN GROUP",
            "identifier": "0A3610",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH GROUP #",
            "identifier": "2061598",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARRINGTON GROUP #",
            "identifier": "95266",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "093085101",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.