Provider Demographics
NPI:1407881105
Name:DRAKE, SCOTT ADRIAN (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ADRIAN
Last Name:DRAKE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4134 NE HAMPSTEAD DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-1619
Mailing Address - Country:US
Mailing Address - Phone:816-516-9589
Mailing Address - Fax:
Practice Address - Street 1:3660 NE RALPH POWELL RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-2357
Practice Address - Country:US
Practice Address - Phone:816-524-7400
Practice Address - Fax:816-525-1700
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1349152W00000X
MOTO2926152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
H797029BMedicare PIN
U25475Medicare UPIN