Provider Demographics
NPI:1043546583
Name:ACKEP, JOHN EMMANUEL KOMIS (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EMMANUEL KOMIS
Last Name:ACKEP
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:EK
Other - Last Name:ACKEP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:235 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-1242
Mailing Address - Country:US
Mailing Address - Phone:732-484-5821
Mailing Address - Fax:
Practice Address - Street 1:864 ROUTE 37 W
Practice Address - Street 2:5723
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5033
Practice Address - Country:US
Practice Address - Phone:732-341-7433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-18
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008387152W00000X
NJ27OA00665300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist