Provider Demographics
NPI:1700048329
Name:ASHBY, DEREK WAYNE (OD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:WAYNE
Last Name:ASHBY
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 1:326 DOZIER AVE
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-2706
Mailing Address - Country:US
Mailing Address - Phone:719-276-0344
Mailing Address - Fax:719-269-7446
Practice Address - Street 1:326 DOZIER AVE
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-2706
Practice Address - Country:US
Practice Address - Phone:719-276-0344
Practice Address - Fax:719-269-7446
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT-2652152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO87751747Medicaid
P00827172OtherRAILROAD MEDICARE
1679525208OtherOFFICE GROUP NPI
1376983924OtherGROUP NPI
P00827172OtherRAILROAD MEDICARE