Provider Demographics
NPI:1356625115
Name:DEREWYANKO, CATHERINE (OD)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:
Last Name:DEREWYANKO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9398 SE SHARON ST
Mailing Address - Street 2:
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455-6835
Mailing Address - Country:US
Mailing Address - Phone:561-801-6749
Mailing Address - Fax:
Practice Address - Street 1:11714 SE FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:HOBE SOUND
Practice Address - State:FL
Practice Address - Zip Code:33455-5303
Practice Address - Country:US
Practice Address - Phone:772-546-4116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4656152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist