Provider Demographics
NPI:1225141203
Name:DR AKEL & FAVALE PL
Entity Type:Organization
Organization Name:DR AKEL & FAVALE PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:FAVALE
Authorized Official - Suffix:II
Authorized Official - Credentials:OD
Authorized Official - Phone:904-786-4442
Mailing Address - Street 1:953 LANE AVE S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-4706
Mailing Address - Country:US
Mailing Address - Phone:904-786-4442
Mailing Address - Fax:904-786-2515
Practice Address - Street 1:953 LANE AVE S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-4706
Practice Address - Country:US
Practice Address - Phone:904-786-4442
Practice Address - Fax:904-786-2515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084977400Medicaid
FL084977400Medicaid
FLAB130Medicare PIN