Derik Hardesty, OD | |
12000 Se 82nd Ave, Clackamas, OR 97086-7721 | |
(503) 659-5947 | |
Not Available |
Full Name | Derik Hardesty |
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Gender | Male |
Speciality | Optometrist |
Location | 12000 Se 82nd Ave, Clackamas, Oregon |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1003497058 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | AT4638 (Oregon) | Primary |
Provider Name | Pacific Eye Group Pc |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1831656925 PECOS PAC ID: 1355682246 Enrollment ID: O20190402001264 |
Mailing Address | Practice Location Address |
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Derik Hardesty, OD 12000 Se 82nd Ave Ste 2193, Happy Valley, OR 97086-7746 Ph: (503) 659-5947 | Derik Hardesty, OD 12000 Se 82nd Ave, Clackamas, OR 97086-7721 Ph: (503) 659-5947 |
Dr. Julia Sirianni, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 15259 Se 82nd Dr Ste 101, Clackamas, OR 97015 Phone: 503-657-0321 Fax: 503-657-7066 | |
Allie De La Cruz, Optometrist Medicare: Not Enrolled in Medicare Practice Location: 15259 Se 82nd Dr Ste 101, Clackamas, OR 97015 Phone: 503-657-0321 | |
Jonathan Jay Attiyah, OD Optometrist Medicare: Not Enrolled in Medicare Practice Location: 15259 Se 82nd Dr Ste 101, Clackamas, OR 97015 Phone: 503-657-0321 Fax: 503-657-7066 | |
Rachel A Jorgensen, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 15259 Se 82nd Dr Ste 101, Clackamas, OR 97015 Phone: 503-657-0321 | |
John William Reski, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 15259 Se 82nd Dr, Suite 101, Clackamas, OR 97015 Phone: 503-657-0321 Fax: 503-657-7066 | |
Mark Edward Mclain, O.D. Optometrist Medicare: Medicare Enrolled Practice Location: 12100 Se Stevens Ct Suite 106, Clackamas, OR 97086 Phone: 503-353-7269 |