Individual
MR. MICKEY LEE DRAKE I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OPTICIAN
Contact information
Practice address
111 PONDEROSA LN, SUITE H, HOT SPRINGS VILLAGE, AR 71909-5018
(501) 984-5955
(501) 984-5955
Mailing address
111 PONDEROSA LN, SUITE H, HOT SPRINGS VILLAGE, AR 71909-5018
(501) 984-5955
(501) 984-5955
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
L-030454
AR
156FX1800X
Optician
L-981101
AR
Other
Enumeration date
02/04/2010
Last updated
02/04/2010
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