Basic Information
| Provider Information | |||||||||
| NPI: | 1811962004 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AKEL | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | FRED | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5205 NORMANDY BLVD | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322054841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9047817717 | ||||||||
| FaxNumber: | 9047816367 | ||||||||
| Practice Location | |||||||||
| Address1: | 5205 NORMANDY BLVD | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322054841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9047817717 | ||||||||
| FaxNumber: | 9047816367 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2006 | ||||||||
| LastUpdateDate: | 08/19/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPC1616 | FL | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.