Organization
ADVANCED EYECARE ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD D DERRYBERRY JR. O.D. (OWNER)
(972) 931-2020
Entity
Organization
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
(972) 407-9452
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4584TG
TX
152WC0802X
Corneal and Contact Management Optometrist
4584TG
TX
152WP0200X
Pediatric Optometrist
4584TG
TX
152WS0006X
Sports Vision Optometrist
4584TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
093085101
—
TX
01
—
0A3610
MEDICARE PTAN GROUP
TX
01
—
2061598
FIRST HEALTH GROUP #
TX
01
—
95266
HARRINGTON GROUP #
TX
Enumeration date
04/18/2007
Last updated
04/20/2009
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