MEDICARE: AKEL MANAGEMENT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OP1616	FL

General Provider Information

NPI Number	:	1073818241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AKEL MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	450 STATE ROAD 13
Second Line	:	SUITE 107
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259-3860
Country	:	US
Telephone Number	:	904-287-3678
Fax Number	:	904-287-3386

Provider Business Practice Location Address
First Line	:	450 STATE ROAD 13
Second Line	:	SUITE 107
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259-3860
Country	:	US
Telephone Number	:	904-287-3678
Fax Number	:	904-287-3386

Authorized Official
Title or Position	:	OPTOMETRIC DOCTOR
Name	:	EDWARD F AKEL
Credential	:	O.D.
Telephone Number	:	904-287-3678

Provider Enumeration Date	:	01/20/2011
Last Update Date	:	07/07/2011

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