Provider Demographics
NPI:1275522245
Name:AKERMAN, GAIL CHANTADULY (OD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:CHANTADULY
Last Name:AKERMAN
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 1:2418 W BENT TREE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-4738
Mailing Address - Country:US
Mailing Address - Phone:480-203-1552
Mailing Address - Fax:623-580-9420
Practice Address - Street 1:2418 W BENT TREE DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-4738
Practice Address - Country:US
Practice Address - Phone:480-203-1552
Practice Address - Fax:623-580-9420
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1162152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ640947Medicaid