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Individual
DR. TERRISA JO DRAKE
Active
Individual
DR. TERRISA JO DRAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
5817TG
TX
152WC0802X
Corneal and Contact Management Optometrist
5817TG
TX
152WP0200X
Pediatric Optometrist
5817TG
TX
152WS0006X
Sports Vision Optometrist
5817TG
TX
152WV0400X
Vision Therapy Optometrist
5817TG
TX
152WX0102X
Occupational Vision Optometrist
5817TG
TX
207WX0009X
Glaucoma Specialist (Ophthalmology) Physician
5817TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134275761
—
TX
01
—
488959ZUNK
MEDICARE GROUP MEMBER PROVIDER NUMBER
TX
Enumeration date
01/26/2007
Last updated
02/19/2019
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