Healthcare Provider Details

I. General information

NPI: 1104969161
Provider Name (Legal Business Name): NICHOLAOS G ROKANAS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 03/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 S FEDERAL HWY
DELRAY BEACH FL
33483-3329
US

IV. Provider business mailing address

1715 S FEDERAL HWY
DELRAY BEACH FL
33483-3329
US

V. Phone/Fax

Practice location:
  • Phone: 561-276-5099
  • Fax: 561-274-9697
Mailing address:
  • Phone: 561-276-5099
  • Fax: 561-274-9697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC 3163
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV007654
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: