MEDICARE: DRAKE EYE CARE, PROFESSIONAL ASSOCIATION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	152WC0802X	Corneal and Contact Management Optometrist
2	152WP0200X	Pediatric Optometrist
3	152WS0006X	Sports Vision Optometrist
4	152WX0102X	Occupational Vision Optometrist
5	152WV0400X	Vision Therapy Optometrist

General Provider Information

NPI Number	:	1831655570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRAKE EYE CARE, PROFESSIONAL ASSOCIATION

Provider Business Mailing Address
First Line	:	1706 SW LOOP 410 STE 102
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78227-1676
Country	:	US
Telephone Number	:	726-999-3632
Fax Number	:

Provider Business Practice Location Address
First Line	:	1706 SW LOOP 410 STE 102
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78227-1676
Country	:	US
Telephone Number	:	726-999-3632
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TERRISA JO DRAKE
Credential	:	OD
Telephone Number	:	806-218-1538

Provider Enumeration Date	:	02/19/2019
Last Update Date	:	02/19/2019

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