Provider Demographics
NPI:1013218254
Name:MAROUN, DEREK SCOTT (OD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:SCOTT
Last Name:MAROUN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 FRESHFIELDS DRIVE
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455
Mailing Address - Country:US
Mailing Address - Phone:843-768-0565
Mailing Address - Fax:843-768-0566
Practice Address - Street 1:634 FRESHFIELDS DRIVE
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455
Practice Address - Country:US
Practice Address - Phone:843-768-0565
Practice Address - Fax:843-768-0566
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1766152W00000X
SC1403152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist