Provider Demographics
NPI:1821244047
Name:DR D J BELCHER P A
Entity Type:Organization
Organization Name:DR D J BELCHER P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BELCHER
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:386-428-2088
Mailing Address - Street 1:2968 S RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32141-7527
Mailing Address - Country:US
Mailing Address - Phone:386-428-2088
Mailing Address - Fax:386-428-6149
Practice Address - Street 1:2968 S RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32141-7527
Practice Address - Country:US
Practice Address - Phone:386-428-2088
Practice Address - Fax:386-428-6149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3200152W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU74824Medicare UPIN
FL20843Medicare PIN