Provider Demographics
NPI:1659535565
Name:DRAKE, JENNIFER B (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:B
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 1:1709 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3578
Mailing Address - Country:US
Mailing Address - Phone:931-840-3501
Mailing Address - Fax:931-840-3505
Practice Address - Street 1:1709 WEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3578
Practice Address - Country:US
Practice Address - Phone:931-840-3501
Practice Address - Fax:931-840-3505
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2827152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist