Provider Demographics
NPI:1184638934
Name:DESIGNER EYEWEAR, INC
Entity Type:Organization
Organization Name:DESIGNER EYEWEAR, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:AKEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-781-7717
Mailing Address - Street 1:5205 NORMANDY BLVD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-4841
Mailing Address - Country:US
Mailing Address - Phone:904-781-7717
Mailing Address - Fax:904-781-6367
Practice Address - Street 1:5205 NORMANDY BLVD
Practice Address - Street 2:SUITE #3
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-4841
Practice Address - Country:US
Practice Address - Phone:904-781-7717
Practice Address - Fax:904-781-6367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
No152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620423600Medicaid
FL4471980001Medicare NSC
FL19504BMedicare ID - Type Unspecified
FL620423600Medicaid
FLDN4378Medicare PIN