Provider Demographics
NPI:1316611585
Name:DAKIN, BRECK AVERY (OD)
Entity type:Individual
Prefix:DR
First Name:BRECK
Middle Name:AVERY
Last Name:DAKIN
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 1:9619 W 57TH PL
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66203-2420
Mailing Address - Country:US
Mailing Address - Phone:620-794-3506
Mailing Address - Fax:
Practice Address - Street 1:5820 LAMAR AVE
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-2612
Practice Address - Country:US
Practice Address - Phone:913-432-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2145152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist