Provider Demographics
NPI:1154543619
Name:DRAKE, ROBERT DARYN (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DARYN
Last Name:DRAKE
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 1:13777 S. STATE HWY. 51
Mailing Address - Street 2:
Mailing Address - City:COWETA
Mailing Address - State:OK
Mailing Address - Zip Code:74429
Mailing Address - Country:US
Mailing Address - Phone:918-486-3951
Mailing Address - Fax:918-486-4606
Practice Address - Street 1:13777 S. STATE HWY. 51
Practice Address - Street 2:
Practice Address - City:COWETA
Practice Address - State:OK
Practice Address - Zip Code:74429
Practice Address - Country:US
Practice Address - Phone:918-486-3951
Practice Address - Fax:918-486-4606
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2238152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist