Derek Frederick Fatura, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901004196 Issued in MI

Practice address

4854 W US Highway 10
Ludington, MI 49431-8703

Phone

(231) 843-6553

NPI assigned

Aug 27, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1156636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1871601294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6123 ALLIENE RD",
            "city": "LUDINGTON",
            "state": "MI",
            "postal_code": "494319653",
            "telephone_number": "231-843-6640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4854 W US HIGHWAY 10",
            "city": "LUDINGTON",
            "state": "MI",
            "postal_code": "494318703",
            "telephone_number": "231-843-6553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FATURA",
        "first_name": "DEREK",
        "middle_name": "FREDERICK",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-27",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAVIS VISION ID#",
            "identifier": "48638",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPECTERA USER ID#",
            "identifier": "WALM19063",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COLE MANAGED VISION CIA#",
            "identifier": "213230",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charles Christopher Eldredge, LLP
• Anthony G Fabaz, D.O.
• Angela Johnson Faber, CNM
• Nicholas Failer, DPT
• Carrie C Failor, MA, CCC-SLP
• Susan S Filter, LMSW
• Lucas Finner
• Jessica Fiting, OTR
• Andrea Flanery, CHW, CCHT
• Holly Mae Flanery

• Optometrist in Ludington, MI
• Providers in Ludington, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.