Provider Demographics
NPI:1780687525
Name:AKEL, ABRAHAM JR (OD)
Entity type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:
Last Name:AKEL
Suffix:JR
Gender:M
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:PO BOX 444
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72654-0444
Mailing Address - Country:US
Mailing Address - Phone:870-424-4900
Mailing Address - Fax:870-424-4979
Practice Address - Street 1:105 SAWGRASS PT
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-3072
Practice Address - Country:US
Practice Address - Phone:870-741-1910
Practice Address - Fax:870-741-6331
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR2002152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
47505Medicare ID - Type Unspecified
T20112Medicare UPIN