Provider Demographics
NPI:1053502864
Name:KOO, DERRICK T (OD)
Entity Type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:T
Last Name:KOO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:20568 STEVENS CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-2130
Mailing Address - Country:US
Mailing Address - Phone:408-777-9000
Mailing Address - Fax:408-777-9009
Practice Address - Street 1:20568 STEVENS CREEK BLVD
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2130
Practice Address - Country:US
Practice Address - Phone:408-777-9000
Practice Address - Fax:408-777-9009
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2010-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAOPT 13260 TPA152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management