Provider Demographics
NPI:1306044631
Name:DRAKE, LAVON HINSHAW
Entity Type:Individual
Prefix:MRS
First Name:LAVON
Middle Name:HINSHAW
Last Name:DRAKE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:AUDREY
Other - Middle Name:LAVON
Other - Last Name:HINSHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6626 US HIGHWAY 264 E
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-7606
Mailing Address - Country:US
Mailing Address - Phone:252-946-3317
Mailing Address - Fax:252-946-7618
Practice Address - Street 1:4557 TECHNOLOGY DR STE 5
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-2145
Practice Address - Country:US
Practice Address - Phone:252-946-7618
Practice Address - Fax:252-946-7618
Is Sole Proprietor?:No
Enumeration Date:2007-07-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory