Derek J Dake OD PC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

DEREK J DAKE OD PC

Practice address

504 W Harrie St
Newberry, MI 49868-1200

Phone

(906) 291-2015

NPI assigned

Sep 11, 2024

Last updated

Sep 11, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Derek J Dake, ODNPI 1740766716

Title

Owner

Phone

(906) 322-3312

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Derek James Dake, OD

  • Optometrist
  • Newberry, MI
  • NPI 1740766716
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1726012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726012800000",
    "number": "1770319352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 W VICTORY WAY",
            "city": "NEWBERRY",
            "state": "MI",
            "postal_code": "498681647",
            "telephone_number": "906-322-3312",
            "fax_number": "906-291-2017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 W HARRIE ST",
            "city": "NEWBERRY",
            "state": "MI",
            "postal_code": "498681200",
            "telephone_number": "906-291-2015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEREK J DAKE OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-11",
        "last_updated": "2024-09-11",
        "certification_date": "2024-09-11",
        "status": "A",
        "authorized_official_last_name": "DAKE",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "906-322-3312",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Derek James Dake, OD
• Dale W Muth OD PLLC
• Dale W Muth OD PLLC
• Denise Magdalene Danaher, WHNP
• Christine Elizabeth Deangelo, PA
• Kaylee Michele Derusha, RDH
• Nichole Drouin
• Sarah Edwards, CBD
• Eric S Laroue DDS PC
• Laura Jeanne Everhart, PHARMD

• Optometrist in Newberry, MI
• Providers in Newberry, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.