MEDICARE: DR AKEL & FAVALE PL

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225141203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR AKEL & FAVALE PL

Provider Business Mailing Address
First Line	:	953 LANE AVE S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32205-4706
Country	:	US
Telephone Number	:	904-786-4442
Fax Number	:	904-786-2515

Provider Business Practice Location Address
First Line	:	953 LANE AVE S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32205-4706
Country	:	US
Telephone Number	:	904-786-4442
Fax Number	:	904-786-2515

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANTHONY FRANK FAVALE II
Credential	:	O.D.
Telephone Number	:	904-786-4442

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	06/13/2016

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Directions to “DR AKEL & FAVALE PL ” Practice Location

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