Provider Demographics
NPI:1669902094
Name:DEVOS, DRAKE ROBERT (OD)
Entity type:Individual
Prefix:
First Name:DRAKE
Middle Name:ROBERT
Last Name:DEVOS
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 1:895 CANTON RD NE BLDG 100
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-8935
Mailing Address - Country:US
Mailing Address - Phone:941-725-1350
Mailing Address - Fax:
Practice Address - Street 1:4450 CALIBRE XING NW STE 1104
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-4104
Practice Address - Country:US
Practice Address - Phone:678-279-1141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5421152W00000X
NYTUV008589152W00000X
GAOPT003083152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty