Healthcare Provider Details

I. General information

NPI: 1447482369
Provider Name (Legal Business Name): ROBYN L. DRAGOO, OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2009
Last Update Date: 08/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27600 NOVI RD
NOVI MI
48377-3420
US

IV. Provider business mailing address

4049 W MAPLE RD
WIXOM MI
48393-1713
US

V. Phone/Fax

Practice location:
  • Phone: 248-348-1032
  • Fax: 248-348-3593
Mailing address:
  • Phone: 248-348-1032
  • Fax: 248-348-3593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901003870
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number4901003870
License Number StateMI

VIII. Authorized Official

Name: ROBYN L DRAGOO
Title or Position: OWNER/DOCTOR
Credential: O.D.
Phone: 248-348-1032