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Individual

DR. PAUL W DERRICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
7229 ST ANDREWS ROAD, IRMO, SC 29063-0722
(803) 781-2212
(803) 233-2883
Mailing address
22 BEACHWOOD W, ISLE OF PALMS, SC 29451-2899
(803) 781-2212
(803) 233-2883

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
496
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
D04966
SC
Enumeration date
03/24/2006
Last updated
12/08/2017
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