MEDICARE: ROXANNE ACHONG OD, PA

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 3204	FL

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

General Provider Information

NPI Number	:	1386665230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROXANNE ACHONG OD, PA

Provider Business Mailing Address
First Line	:	10101 W COLONIAL DR
Second Line	:	SUITE 100
City	:	OCOEE
State	:	FL
Zip	:	34761-4213
Country	:	US
Telephone Number	:	407-445-5170
Fax Number	:	407-299-5036

Provider Business Practice Location Address
First Line	:	10101 W COLONIAL DR
Second Line	:	SUITE 100
City	:	OCOEE
State	:	FL
Zip	:	34761-4213
Country	:	US
Telephone Number	:	407-445-5170
Fax Number	:	407-299-5036

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROXANNE ACHONG
Credential	:	OD
Telephone Number	:	407-445-5170

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	03/07/2008

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