Kristen Elaine Derry

Primary specialty

OptometristTaxonomy code 152W00000X

License

60503088 Issued in WA

Practice address

12116 SE Mill Plain Blvd Ste 1
Vancouver, WA 98684-6000

Phone

(360) 719-1512

Fax

(503) 254-0576

NPI assigned

Apr 22, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

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

Pacific University - College of Optometry, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

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

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.

• Derry Family Eyecare LLC

  • Optometrist
  • Vancouver, WA
  • NPI 1396459616
  Medicare reassignment NPD Authorized official
• Richardson Eye Clinic, PLLC

  • Optometrist
  • Vancouver, WA
  • NPI 1942655246
  NPD

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

{
    "created_epoch": "1366588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664755200000",
    "number": "1730523788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5105 SW ELM AVE",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970054230",
            "telephone_number": "541-659-9318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12116 SE MILL PLAIN BLVD STE 1",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986846000",
            "telephone_number": "360-719-1512",
            "fax_number": "503-254-0576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERRY",
        "first_name": "KRISTEN",
        "middle_name": "ELAINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-04-22",
        "last_updated": "2022-10-03",
        "certification_date": "2022-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "3579ATI",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "60503088",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500740584",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tania B. Derington, CRNA
• Dermatology Associates
• Dermatology Associates of Southwest Washington, PLLC
• Matthew Derosa
• Derry Family Eyecare LLC
• Celia Katherine Dervan, MD
• Lisa Danielle Desmarais, CNM
• Emma Rae Destromp, MS CCC-SLP
• Alexis Dettling
• Dana Leanne Detweiler, DPT

• Optometrist in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2022; 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.