Provider Demographics
NPI:1760717847
Name:DRAAYER, PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:DRAAYER
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 1:2100 S MARION RD STE 125
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-3648
Mailing Address - Country:US
Mailing Address - Phone:605-965-4733
Mailing Address - Fax:605-965-5209
Practice Address - Street 1:2100 S MARION RD STE 125
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-3648
Practice Address - Country:US
Practice Address - Phone:605-322-1702
Practice Address - Fax:605-322-1704
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD684152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS50718Medicaid