MEDICARE: MR. NICHOLAOS G ROKANAS O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPC 3163	FL
2	152W00000X	Optometrist	TUV007654	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104969161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NICHOLAOS G ROKANAS O.D.

Provider Business Mailing Address
First Line	:	1715 S FEDERAL HWY
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-3329
Country	:	US
Telephone Number	:	561-276-5099
Fax Number	:	561-274-9697

Provider Business Practice Location Address
First Line	:	1715 S FEDERAL HWY
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-3329
Country	:	US
Telephone Number	:	561-276-5099
Fax Number	:	561-274-9697

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	03/10/2017

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Directions to “ MR. NICHOLAOS G ROKANAS O.D.” Practice Location

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