Active NPI
Kelly Jean Drake, O.D.
- Optometrist
- Grayling, MI
National Provider Identifier
1255521902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 4901004442
- Practice address
- 110 E Michigan Ave
Grayling, MI 49738-1741 - Phone
- (989) 348-2833
- Fax
- (989) 843-2834
- NPI assigned
- Jul 30, 2007
- Last updated
- Jun 6, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4901004442 | MI | Primary |
Addresses
Primary practice location
110 E Michigan Ave
Grayling, MI 49738-1741
Mailing address
1299 Silery Rd
Indian River, MI 49749-9513
Phone (989) 513-1968
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Melissa M David OD PLLC | Optometrist | Past | Accepting new patients |
| Pasqua LLC | Optometrist | Past | Accepting new patients |
| Dewberry Medical Co | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Eyewear Supplier
- Detroit, MI
- NPI 1932551645
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185753600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1496707200000",
"number": "1255521902",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1299 SILERY RD",
"city": "INDIAN RIVER",
"state": "MI",
"postal_code": "497499513",
"telephone_number": "989-513-1968"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 E MICHIGAN AVE",
"city": "GRAYLING",
"state": "MI",
"postal_code": "497381741",
"telephone_number": "989-348-2833",
"fax_number": "989-843-2834"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DRAKE",
"first_name": "KELLY",
"middle_name": "JEAN",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-07-30",
"last_updated": "2017-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MI",
"license": "4901004442",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grayling, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.