Individual
DR. DONALD DEAN DERRYBERRY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
18170 DALLAS PKWY, SUITE 402, DALLAS, TX 75287-7137
(972) 931-2020
Mailing address
18170 DALLAS PKWY, SUITE 402, DALLAS, TX 75287-7137
(972) 931-2020
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4584TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8F21032
MEDICARE PTAN INDIVIDUAL
TX
Enumeration date
07/07/2005
Last updated
04/20/2009
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