JOHN C. DERICKSON OD, PA (NPI# 1356686976) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356686976 |
| Entity Type | Organization |
| Organization Name | JOHN C. DERICKSON OD, PA |
| Other Organization Name | DERICKSON VISION CONSULTANTS |
| Practice Address |
8771 Perimeter Park Ct Suite 101 Jacksonville FL 32216-6396 |
| Practice Telephone | 9049978585 |
| Mailing Telephone | 9049978585 |
| Enumeration Date | 2012-12-07 |
| Last Update Date | 2012-12-07 |
| Authorized Official Name | DR. JOHN CHRISTIAN DERICKSON (OWNER) |
| Authorized Official Telephone | 9049978585 |
| Authorized Official Credential | O.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152WC0802X |
Optometrist Specialization: Corneal and Contact Management |
OPC3107 | FL | Eye and Vision Services Providers |
| Other Name | Type Code |
|---|---|
| Derickson Vision Consultants | Doing Business As Name - Organization |
| Street Address |
8771 PERIMETER PARK CT SUITE 101 |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32216-6396 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972505477 | John C. Derickson | Optometrist | 8771 Perimeter Park Ct, Suite 101, Jacksonville, FL 32216-6396 | 2005-08-15 |
| 1245616317 | Matthew Sutton | Optometrist | 8771 Perimeter Park Ct, Suite 101, Jacksonville, FL 32216-6396 | 2015-07-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013524925 | Renee Cherie Titus | Behavior Technician | Growing Together Center 6789 Southpoint Parkway, Building 100, Jacksonville, FL 32216 | 2020-09-24 |
| 1811546575 | First Coast Orthopedic Center, LLC | Clinic/Center | 4035 Southpoint Boulevard, Jacksonville, FL 32216 | 2019-09-05 |
| 1922578558 | Fatima Hussain Crofton | Optometrist | 7051 Southpoint Parkway S 300, Jacksonville, FL 32216 | 2018-11-27 |
| 1154802833 | John-paul Pham | Internal Medicine | 4141 Southpoint Drive East, Suite D, Jacksonville, FL 32216 | 2018-08-22 |
| 1790279479 | Joseph Richard Kennedy | Physician Assistant | 6650 Corporate Center Pkwy Apt 1604, Jacksonville, FL 32216 | 2018-06-18 |
| 1801304357 | Kelli M. Tyson | Nurse Practitioner | 3550 University Blvd. S., Ste 302, Jacksonville, FL 32216 | 2018-01-18 |
| 1376054809 | Angela M Whittinghill | Counselor | 8833 Perimeter Park Blvd #702, Jacksonville, FL 32216 | 2017-10-24 |
| 1629508072 | Zoryana Yufan | Dentist | 8750 Perimeter Park Blvd Ste 101, Jacksonville, FL 32216 | 2017-06-19 |
| 1700318896 | Christina Kaczmarek | Behavior Technician | 6816 Southpoint Pkwy Ste 500, Jacksonville, FL 32216 | 2017-03-29 |
| 1932640422 | Loudine Racius | Nurse Practitioner | 8539 Gate Parkway W, Unit 1422, Jacksonville, FL 32216 | 2017-03-16 |
| Find all providers in zip 32216 | ||||
| Taxonomy Code | 152WC0802X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Specialization | Corneal and Contact Management |
| The professional activities performed by an Optometrist related to the fitting of contact lenses to an eye, ongoing evaluation of the cornea’s ability to sustain successful contact lens wear, and treatment of any external eye or corneal condition which can affect contact lens wear. |
| Notes: Source: American Optometric Association [1/1/2009: added definition, added source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598871048 | Daniel R Mcintosh | Optometrist | 3840 Belfort Rd Ste 105, Jacksonville, FL 32216-6202 | 2006-08-21 |
| 1437154283 | Brian S Armitage | Optometrist | 8081 Philips Hwy, Suite 9, Jacksonville, FL 32256-7464 | 2005-06-17 |
| 1184197394 | University Eye Center, LLC | Optometrist | 1 Unf Drive, Bldg 8, 1303, Jacksonville, FL 32224 | 2019-01-10 |
| 1982817193 | Jack Rubin | Optometrist | 11406 San Jose Blvd, Ste 1, Jacksonville, FL 32223-7963 | 2007-05-07 |
| 1669591129 | Richard Foster | Optometrist | 2000 John Harden Dr, Jacksonville, AR 72076-2730 | 2007-03-28 |
| 1790818466 | Innovision Medical Pa | Optometrist | 8075 Gate Pkwy W, Suite 102 & 103, Jacksonville, FL 32216-3684 | 2007-03-13 |
| 1740207182 | Brian S Armitage, O.d., P.a. | Optometrist | 8081 Philips Hwy, Suite 9, Jacksonville, FL 32256-7464 | 2006-07-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477173987 | Yunuseyeassociates,pa | Optometrist | 3950 S Us Hwy 17/92, Ste 1008, Casselberry, FL 32707-3270 | 2020-04-24 |
| 1053978122 | Yanara Barreras | Optometrist | 8888 Sw 136th St Ste 391, Miami, FL 33176-5801 | 2019-05-23 |
| 1700378163 | Lindsey Marie Walsh | Optometrist | 601 E Dixie Ave Ste 201, Leesburg, FL 34748-5991 | 2018-06-01 |
| 1225574783 | Miramar Vision Center | Optometrist | 9939 Miramar Pkwy, Miramar, FL 33025-2397 | 2017-01-09 |
| 1366807653 | Isee Eyecare Mobile, Inc. | Optometrist | 10860 Nw 37th Ct, Coral Springs, FL 33065-2701 | 2015-12-31 |
| 1053789644 | Eyepromote, Inc. | Optometrist | 2775 Nw 49th Ave, Suite 205-146, Ocala, FL 34482-6212 | 2015-09-13 |
| 1982086211 | Florida Eye Doctors, Inc | Optometrist | 1000 North Congress Avenue Suite 150, Boynton Beach, FL 33426-3337 | 2015-06-23 |
| 1760877757 | Kenneth Maller | Optometrist | 5333 N Dixie Hwy Ste 101, Oakland Park, FL 33334-3453 | 2015-04-06 |
| 1013314681 | Precision Eye Care Center LLC | Optometrist | 4900 N Highway 19a, Mount Dora, FL 32757-2042 | 2014-11-26 |
| 1801293709 | Debra A. Shim, Od, Pa | Optometrist | 451 University Blvd Ste 102, Jupiter, FL 33458-3102 | 2014-11-21 |
| Find all providers with the same taxonomy | ||||
| City | JACKSONVILLE |
| Zip Code | 32216 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.