Daryn W. Derstine, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2773ATI Issued in OR

Practice address

6539 SE Milwaukie Ave
Portland, OR 97202-5519

Phone

(503) 236-6008

Fax

(503) 236-2057

NPI assigned

Jul 17, 2006

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

Medicare fee-for-service enrollment

Enrolled in OR

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 Alabama Birmingham - School of Optometry, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Moreland Family Eye Care PCGroup PAC ID 5496089898, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: drderstine@moreland-vs.direct.kno2fy.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Moreland Family Eye Care PC

  • Optometrist
  • Portland, OR
  • NPI 1487156683
  Medicare reassignment Care Compare group NPD Authorized official
• Master Eye Associates, P.C.

  • Optometrist
  • Beaverton, OR
  • NPI 1245671924
  NPD (past)
• Scott J Wojciechowski OD

  • Optometrist
  • Portland, OR
  • NPI 1730329137
  NPD (past)

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565827200000",
    "number": "1669490686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6539 SE MILWAUKIE AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972025519",
            "telephone_number": "503-236-6008",
            "fax_number": "503-236-2057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6539 SE MILWAUKIE AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972025519",
            "telephone_number": "503-236-6008",
            "fax_number": "503-236-2057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERSTINE",
        "first_name": "DARYN",
        "middle_name": "W.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2019-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "2773ATI",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Derr
• Kerri D Derrevere, MD
• Sara Mae Fels Derrickson, ED.S.
• Sean Robert Derrickson III, MSW
• Christina T Derstine, MD
• Sarah A Dervan, MD
• Amish J Desai, MD
• Amrita Desai, M.D.
• Michelle Loretta Desai, MSW
• Nisha Shah Desai, MD

• All providers in Portland, OR
• Optometrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2019; 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.