Healthcare Provider Details

I. General information

NPI: 1821244047
Provider Name (Legal Business Name): DR D J BELCHER P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2008
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2968 S RIDGEWOOD AVE
EDGEWATER FL
32141-7527
US

IV. Provider business mailing address

2968 S RIDGEWOOD AVE
EDGEWATER FL
32141-7527
US

V. Phone/Fax

Practice location:
  • Phone: 386-428-2088
  • Fax: 386-428-6149
Mailing address:
  • Phone: 386-428-2088
  • Fax: 386-428-6149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC 3200
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. DONNA J BELCHER
Title or Position: OWNER
Credential: O D
Phone: 386-428-2088