Provider Demographics
NPI:1699742734
Name:AKEL, GARY MARK (OD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:MARK
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 1:953 LANE AVE S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-4706
Mailing Address - Country:US
Mailing Address - Phone:904-786-4442
Mailing Address - Fax:904-786-2515
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
Practice Address - Country:US
Practice Address - Phone:904-786-4442
Practice Address - Fax:904-786-2515
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1456152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084977400Medicaid
FL19102YMedicare PIN
T88032Medicare UPIN
FL0548000001Medicare NSC