Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Derek Alan Black, OD

Individual provider Optometrist · NPI 1114353232

Dr. Derek Alan Black, OD is an Optometry in Cumming, Georgia. Graduated from Southern College of Optometry in 2013, 13 years ago. Practices with Lake Lanier Eye Care, LLC, a 2-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
13
Trained at
Southern College of Optometry
Licensed in
GA
In the registry since
2013
What do these letters mean?
OD — Doctor of Optometry
An optometrist: examines eyes, prescribes glasses and contacts, and treats many eye conditions.

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Practice location Address checks out

1211 Bald Ridge Marina Rd
Cumming, GA 30041-8484
Phone: (470) 239-6625
Fax: (470) 239-6626
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 9300 Dewitt Loop, Fort Belvoir, VA 22060-5285 — (571) 231-1431

Specialties & licences

Optometrist (primary) Taxonomy 152W00000X · Licence OPT002922 (GA)

Record details

NPI number1114353232
Entity typeIndividual (Type 1)
GenderMale
Credentials OD
Sole proprietorNo
NPI enumeratedSeptember 20, 2013
Last updated in NPPESOctober 26, 2020
Certification dateOctober 26, 2020
Mailing address1211 Bald Ridge Marina Rd, Cumming, GA 30041-8484

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOPTOMETRY
Medical schoolSOUTHERN COLLEGE OF OPTOMETRY
Graduated 2013 (13 years in practice)
Group practice Lake Lanier Eye Care, Llc — 2 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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