Most Relevant Information
Provider Data
| NPI Number: | 1003497058 |
| Provider Name: | DERIK HARDESTY OD |
| Entity Type: | Individual |
| Taxonomy Code: | 152W00000X |
| Specialty: | Optometrist |
| License Number: | AT4638 |
Most Important Dates
| Enumeration Date: | 04/20/2021 |
| Last Updated: | 07/05/2022 |
Provider Practice Location
12000 SE 82ND AVE
CLACKAMAS
OR
970867721
Practice Location Phone/Fax
| Phone: | 5036595947 |
| Fax: |
Provider Mailing Location
12000 SE 82ND AVE STE 2193
HAPPY VALLEY
OR
970867746
Provider Mailing Phone/Fax
| Phone: | 5036595947 |
| Fax: |