Healthcare Provider Details

I. General information

NPI: 1366463275
Provider Name (Legal Business Name): ROXANNE ACHONG-COAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 W COLONIAL DR SUITE 100
OCOEE FL
34761-4213
US

IV. Provider business mailing address

10101 W COLONIAL DR SUITE 100
OCOEE FL
34761-4213
US

V. Phone/Fax

Practice location:
  • Phone: 407-445-5170
  • Fax: 407-299-5036
Mailing address:
  • Phone: 407-445-5170
  • Fax: 407-299-5036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOP 3204
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: