Provider Demographics
NPI:1952426298
Name:DRAGOO, ROBYN LEIGH (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBYN
Middle Name:LEIGH
Last Name:DRAGOO
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 1:4049 W MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393-1713
Mailing Address - Country:US
Mailing Address - Phone:248-348-1032
Mailing Address - Fax:248-348-3593
Practice Address - Street 1:25500 MEADOWBROOK RD STE 135
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1880
Practice Address - Country:US
Practice Address - Phone:248-893-6180
Practice Address - Fax:248-348-3593
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003870152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900F367220OtherBLUE CROSS BLUE SHIELD
MI230630OtherNVA
MI9-18418OtherEYEMED
MIOM 92760Medicare ID - Type Unspecified