| Doctor Name: | MR. MICKEY LEE DRAKE |
| NPI Number: | 1053643817 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | OPTICIAN |
| License Number: | L-981101 |
| Business Practice Address: | 111 Ponderosa Ln Suite H Hot Springs Village, AR - 719095018 |
| Business Phone Number: | 5019845955 |
| Business Fax Number: | 5019845955 |
| Mailing Address: | 111 Ponderosa Ln, Suite H HOT SPRINGS VILLAGE |
| State: | AR |
| Postal Code: | 719095018 |
| Phone Number: | 5019845955 |
| Fax Number: | 5019845955 |
| NPI Enumeration Date: | 02/04/2010 |
| NPI Last Update Date: | 02/04/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | L-981101 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | AR |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |