MEDICARE: DR. DONNA J BELCHER II 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	OPC3200	FL

General Provider Information

NPI Number	:	1972500726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONNA J BELCHER II O.D.

Provider Business Mailing Address
First Line	:	1890 SPRUCE CREEK BLVD
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-6780
Country	:	US
Telephone Number	:	386-304-8941
Fax Number	:

Provider Business Practice Location Address
First Line	:	1369 BEVILLE RD
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32119-1529
Country	:	US
Telephone Number	:	386-761-1323
Fax Number	:	386-761-8210

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/09/2007

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