Healthcare Provider Details

I. General information

NPI: 1972500726
Provider Name (Legal Business Name): DONNA J BELCHER II O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1369 BEVILLE RD
DAYTONA BEACH FL
32119-1529
US

IV. Provider business mailing address

1890 SPRUCE CREEK BLVD
PORT ORANGE FL
32128-6780
US

V. Phone/Fax

Practice location:
  • Phone: 386-761-1323
  • Fax: 386-761-8210
Mailing address:
  • Phone: 386-304-8941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC3200
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: