MEDICARE: STEVEN P DRAKE OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1375	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811993462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN P DRAKE OD

Provider Business Mailing Address
First Line	:	PO BOX 620
Second Line	:
City	:	GILLETT
State	:	WI
Zip	:	54124-0620
Country	:	US
Telephone Number	:	920-855-2117
Fax Number	:	920-855-2331

Provider Business Practice Location Address
First Line	:	130 E MAIN ST
Second Line	:
City	:	GILLETT
State	:	WI
Zip	:	54124-9386
Country	:	US
Telephone Number	:	920-855-2117
Fax Number	:	920-855-2331

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	09/30/2013

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Directions to “ STEVEN P DRAKE OD” Practice Location

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