Jack Derby, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

18003896A Issued in IN

Practice address

506 S Washington St
Marion, IN 46953-1961

Phone

(765) 662-6648

Fax

(765) 662-6250

NPI assigned

Jun 15, 2015

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 IN

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

Indiana University - School of Optometry, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Marion Family Optometrists IncGroup PAC ID 5395803290, 7 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Marion Family Optometrists, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Wabash, IN
  • NPI 1457534125

  Optometrist

  Medicare reassignment Care Compare group NPD
• Marion Family Optometrists, Inc.

  • Optometrist
  • Wabash, IN
  • NPI 1144650680
  NPD
• J Jeffrey Hughes OD

  • Optometrist
  • Huntington, IN
  • NPI 1750559068
  NPD (past)

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

{
    "created_epoch": "1434326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434326400000",
    "number": "1841671948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "506 S WASHINGTON ST",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469531961",
            "telephone_number": "765-662-6648",
            "fax_number": "765-662-6250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 S WASHINGTON ST",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469531961",
            "telephone_number": "765-662-6648",
            "fax_number": "765-662-6250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERBY",
        "first_name": "JACK",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-15",
        "last_updated": "2015-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18003896A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Escolastico Ausejo Deloria Jr., M.D.
• Tara Demarcus
• Lori Ann Denney, P.T.A.
• Megan Marie Denny, DO
• Dental Professionals of Indiana, P.C.
• Dermatology, PC
• Ashley Jo Derry, RBT-24-375583
• Stephen Lentz Derryberry Jr.
• Gautam Deshpande, PT
• Andrea Lynn Detamore

• Optometrist in Marion, IN
• Providers in Marion, IN by specialty
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2015; 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.