Provider Demographics
NPI:1649307372
Name:DRAKE & ASSOCIATES, OPTOMETRISTS, P.A.
Entity type:Organization
Organization Name:DRAKE & ASSOCIATES, OPTOMETRISTS, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:913-894-2020
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:816-835-2020
Mailing Address - Fax:
Practice Address - Street 1:15601 W 87TH STREET PKWY
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219-1435
Practice Address - Country:US
Practice Address - Phone:913-894-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1364152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSH790000BMedicare PIN
U05341Medicare UPIN
KS6092090001Medicare NSC