Healthcare Provider Details

I. General information

NPI: 1407828379
Provider Name (Legal Business Name): BRADLEY S. DRAKE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

697 HIGHWAY 31 NW SUITE 41
HARTSELLE AL
35640-4408
US

IV. Provider business mailing address

697 HIGHWAY 31 NW
HARTSELLE AL
35640-4408
US

V. Phone/Fax

Practice location:
  • Phone: 256-773-3997
  • Fax: 256-773-3997
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS-A49-TA-629
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRAD DRAKE
Title or Position: PRESIDENT
Credential: O.D.
Phone: 256-773-3997