Provider Demographics
NPI:1811962004
Name:AKEL, EDWARD FRED (OD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:FRED
Last Name:AKEL
Suffix:
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 1:5205 NORMANDY BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-4841
Mailing Address - Country:US
Mailing Address - Phone:904-781-7717
Mailing Address - Fax:904-781-6367
Practice Address - Street 1:5205 NORMANDY BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-4841
Practice Address - Country:US
Practice Address - Phone:904-781-7717
Practice Address - Fax:904-781-6367
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1616152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19504BMedicare ID - Type Unspecified
FL4471980001Medicare NSC