Provider Demographics
NPI:1780791194
Name:DRAPER, MEGAN (OD)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:
Last Name:DRAPER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 WINNEBAGO ST
Mailing Address - Street 2:UNIT 311
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-5565
Mailing Address - Country:US
Mailing Address - Phone:312-498-1157
Mailing Address - Fax:
Practice Address - Street 1:2101 W BROADWAY
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53713-1638
Practice Address - Country:US
Practice Address - Phone:608-222-9420
Practice Address - Fax:608-222-9583
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007044-1152W00000X
WI3175-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist