Provider Demographics
NPI:1316293368
Name:DRAKE, ERIC DENNIS (OD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:DENNIS
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 1:965 E 700 S
Mailing Address - Street 2:STE 100
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4084
Mailing Address - Country:US
Mailing Address - Phone:435-619-5870
Mailing Address - Fax:
Practice Address - Street 1:965 E 700 S STE 100
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4084
Practice Address - Country:US
Practice Address - Phone:435-673-5577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6162362-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist