Provider Demographics
NPI:1437162393
Name:FABER, GANE II (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:GANE
Middle Name:
Last Name:FABER
Suffix:II
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:B.J.F.
Other - Middle Name:
Other - Last Name:ENTERPRISES INC.
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4800 NE 20TH TER
Mailing Address - Street 2:SUITE 305
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4510
Mailing Address - Country:US
Mailing Address - Phone:954-565-4009
Mailing Address - Fax:954-565-4009
Practice Address - Street 1:4800 NE 20TH TER
Practice Address - Street 2:SUITE 305
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4510
Practice Address - Country:US
Practice Address - Phone:954-565-4009
Practice Address - Fax:954-565-4009
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLD03253156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0937050001Medicare NSC