Dr. Derek James Dake, OD
Optometrist in Newberry, MI. Individual provider (NPI-1).
NPI number1740766716
StatusActive
Last updated in NPPESJul 12, 2018
Details
- NPI
- 1740766716
- Entity type
- Individual (NPI-1)
- Name
- Dr. Derek James Dake
- Credential
- OD
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jul 12, 2018
- Last updated
- Jul 12, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | 4901005127 | MI | Yes |
Practice location
504 W Harrie StNewberry, MI 49868-1200
Phone 906-291-2015
Mailing address
315 W Victory WayNewberry, MI 49868-1647
Phone 906-322-3312
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