Healthcare Provider Details

I. General information

NPI: 1174558878
Provider Name (Legal Business Name): GARY D. ENKER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6215 N FEDERAL HWY
FORT LAUDERDALE FL
33308-1903
US

IV. Provider business mailing address

6215 N. FEDERAL HWY
FORT LAUDERDALE FL
33308-1903
US

V. Phone/Fax

Practice location:
  • Phone: 954-491-7141
  • Fax: 954-491-7164
Mailing address:
  • Phone: 954-491-7141
  • Fax: 954-491-7164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2511
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: