Provider Demographics
NPI:1245222934
Name:AKER, CARROLL GREGORY (OD)
Entity type:Individual
Prefix:DR
First Name:CARROLL
Middle Name:GREGORY
Last Name:AKER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-3548
Mailing Address - Country:US
Mailing Address - Phone:321-269-2021
Mailing Address - Fax:321-269-2119
Practice Address - Street 1:338 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-3548
Practice Address - Country:US
Practice Address - Phone:321-269-2021
Practice Address - Fax:321-269-2119
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2007-09-19
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
FLOPC2006152W00000X, 152WC0802X, 152WX0102X
156FC0800X, 156FC0801X, 156FX1201X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter
No156FX1201XEye and Vision Services ProvidersTechnician/TechnologistOptometric Assistant
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19511XMedicare PIN