David Peter Derose, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OEG001317 Issued in PA

Practice address

150 W Hillcrest Dr
Bloomsburg, PA 17815-6710

Phone

(570) 204-6547

Fax

(570) 387-9135

NPI assigned

Aug 30, 2006

Last updated

Mar 7, 2023By the provider in NPPES

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 2

Medicare fee-for-service enrollment

Enrolled in PA

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Independence Corporation

  dba Eyeland Optical Inc.

  • Optometrist
  • Whitehall, PA
  • NPI 1972549657
  Medicare reassignment NPD
• Independence Corporation

  dba Eyeland Optical Inc.

  • Optometrist
  • Ephrata, PA
  • NPI 1386928208
  NPD

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1992814073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 W HILLCREST DR",
            "city": "BLOOMSBURG",
            "state": "PA",
            "postal_code": "178156710",
            "telephone_number": "570-204-6547",
            "fax_number": "570-387-9135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 W HILLCREST DR",
            "city": "BLOOMSBURG",
            "state": "PA",
            "postal_code": "178156710",
            "telephone_number": "570-204-6547",
            "fax_number": "570-387-9135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEROSE",
        "first_name": "DAVID",
        "middle_name": "PETER",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG001317",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA LICENSE NUMBER",
            "identifier": "OEG001317",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEISINGER HEALTH PLAN #",
            "identifier": "27705",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patricia Deitrich
• Sipora Dejesus
• Jeremy Scott Demarco, LPC
• Timothy James Dennen, M.D.
• Gabrielle Deparasis
• Madison Dewease
• Alyssa Diehl
• Christine Ann Dopp, PA-C
• John Allen Douglas III, M.D.
• Dr. Michelle R. Trump PC

• Optometrist in Bloomsburg, PA
• Providers in Bloomsburg, PA by specialty
• Optometrist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.