Provider Demographics
NPI:1760459549
Name:FAVALE, ANTHONY FRANK II (OD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:FRANK
Last Name:FAVALE
Suffix:II
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
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
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2824152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7684423OtherCIGNA
FL7684423OtherCIGNA
FL20750ZMedicare PIN