Healthcare Provider Details

I. General information

NPI: 1356625115
Provider Name (Legal Business Name): CATHERINE DEREWYANKO O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11714 SE FEDERAL HWY
HOBE SOUND FL
33455-5303
US

IV. Provider business mailing address

9398 SE SHARON ST
HOBE SOUND FL
33455-6835
US

V. Phone/Fax

Practice location:
  • Phone: 772-546-4116
  • Fax:
Mailing address:
  • Phone: 561-801-6749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC4656
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: