=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174558878
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GARY D. ENKER OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2006
-----------------------------------------------------
Last Update Date | 05/04/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6215 N FEDERAL HWY
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33308-1903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-491-7141
-----------------------------------------------------
Fax | 954-491-7164
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6215 N. FEDERAL HWY
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33308-1903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-491-7141
-----------------------------------------------------
Fax | 954-491-7164
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2511
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------