Provider Demographics
NPI:1629278049
Name:DRAKE, JENNI CORINNE (OD)
Entity Type:Individual
Prefix:
First Name:JENNI
Middle Name:CORINNE
Last Name:DRAKE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7590 SADDLEBACK RD
Mailing Address - Street 2:
Mailing Address - City:BEULAH
Mailing Address - State:CO
Mailing Address - Zip Code:81023-9502
Mailing Address - Country:US
Mailing Address - Phone:215-870-4624
Mailing Address - Fax:844-239-7476
Practice Address - Street 1:4491 BENT BROTHERS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:COLORADO CITY
Practice Address - State:CO
Practice Address - Zip Code:81019-2015
Practice Address - Country:US
Practice Address - Phone:719-676-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001914152W00000X
CO2603152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist