MEDICARE: ANTHONY FRANK FAVALE II OD

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	OPC2824	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7684423	OTHER	FL	CIGNA

General Provider Information

NPI Number	:	1760459549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY FRANK FAVALE II OD

Provider Business Mailing Address
First Line	:	8614 WESTWOOD CENTER DR FL 9
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22182-2442
Country	:	US
Telephone Number	:	703-847-8899
Fax Number	:	571-223-6780

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	03/10/2023

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